Efficacy and safety profile of autologous blood versus tetracycline pleurodesis for malignant pleural effusion

Abstract

Objectives: Autologous blood pleurodesis (ABP) is used for the treatment of pneumothorax with a good efficacy. The aim of this study is to determine the efficacy and safety of ABP in the treatment of malignant pleural effusion (MPE). Methods: A prospective study was conducted at Songklanagarind Hospital, Thailand. Symptomatic MPE patients were randomized to receive pleurodesis with either autologous blood or tetracycline. In the ABP group, 100 ml of autologous venous blood was instilled via chest tube followed by 50 ml of sterile normal saline (NSS). In the tetracycline group, 20 ml of 1% lidocaine diluted in 30 ml NSS was instilled followed by 1 g of tetracycline diluted in 100 ml of NSS. The chest tube was clamped for 2 hours, then reconnected to suction and removed. Pleurodesis effectiveness was evaluated according to Paladine's criteria and adverse events were recorded. Results: A total of 48 symptomatic MPE patients were recruited. Of these, 24 cases were randomized to receive ABP and 24 cases received tetracycline. There was no difference between the two groups in baseline characteristics. The overall success rate of pleurodesis was the same in both the autologous blood group and the tetracycline group (83.4% versus 87.5%, p = 0.36). In the ABP group, the pain score and fever were significantly lower (8.3% versus 29.1%, p = 0.003) and there was a small percentage of cases that needed analgesia (4.2% versus 75%, p < 0.001); no serious events occurred. Conclusions:: ABP was as effective as tetracycline in the treatment of MPE. ABP produced less pain and fever, and could shorten the hospital stay.

Malignant pleural mesothelioma: an update on investigation, diagnosis and treatment

“…Consequently patients with trapped lung or extensive tumour bulk should be considered for alternative methods of pleural fluid control. Many chemical agents have been used for pleurodesis, but sterile, medical-grade talc appears to be the safest and most effective [125][126][127][128][129]. The British Thoracic Society recommends talc as the pleurodesis agent of choice, although other agents such as bleomycin and tetracycline are used in other countries [30,130].…”

Autologous blood patch pleurodesis: An effective but underused method

“…Moreover, pleurodesis has also been used in catamenial pneumothorax, refractory hydrothorax secondary to ascites, chylothorax, malignant pleural effusion, and other medical situations. [ 4 5 ]…”

A successful case of a para-aortic lymphocele treated with autologous peripheral blood injection

“…Autologous peripheral blood is well used for the treatment of pneumothorax or malignant pleural effusion. It is known that the coagulated blood adheres to the lung as a patch and seals the air leak directly [18] , [19] . In this case, autologous peripheral blood was selected for sclerotherapy because it was less invasive for the jejunum, which was located close to the lymphocele.…”