Incidence of Bleeding Complications With Flexible Bronchoscopy in Cancer Patients With Thrombocytopenia

Abstract

Background: Bronchoscopy is a safe procedure, but current guidelines recommend transfusion for platelets <20 K/μL. Studies of bronchoscopy in thrombocytopenia are limited. Objectives: Our objective was to evaluate the incidence of bleeding with flexible bronchoscopy in those with thrombocytopenia especially those <20 K/μL. Method: We performed a retrospective review of all flexible bronchoscopies between June 1, 2008 and December 31, 2010. Biopsies and therapeutic procedures were excluded. The χ2, Fisher exact, and Rank-sum test were conducted to evaluate associations of clinically significant bleeding. Results: There were 1711 patients who underwent 2053 flexible bronchoscopies. Cancer diagnosis included hematologic (61.3%) and solid organ malignancy (34.9%). Half of the bronchoscopies had moderate to severe thrombocytopenia (<100 K/μL) with the following ranges: 14.7% with 50 to <100 K/μL, 20.6% with 20 to <50 K/μL, 10.6% with 10 to <20 K/μL, 4.1% with <10 K/μL. Platelet transfusion was given in 90.6% of those with platelets <10 K/μL and 55.5% of those with platelets 10 to <20 K/μL. The nasal route for bronchoscopy was used in 92.4%. Bleeding complication rate however was 1.1% (0.2% major) and not affected by platelets. Conclusion: Bronchoscopy with lavage can be safely performed without platelet transfusion in those with platelets of ≥10 K/μL. In the absence of nasal bleeding, trauma, or deformity, the nasal route can be used for bronchoscopy.

Precautionary strategy for high‐risk airway bleeding cases during robotic‐assisted bronchoscopy

“…Different platelet thresholds have been stablished as “safe,” ranging from 20,000 to 50,000 [1]. A significant contributor to the perpetuation of this dilemma is the generalization of the term “bronchoscopy.” A threshold of 20,000, or even lower, may be safe for a routine airway inspection with bronchoalveolar lavage; however, the same threshold may be far from safe for more invasive interventions such as needle biopsy, transbronchial biopsy, or cryo‐biopsy [2,3]. An airway haemorrhage of as little as 150 mL could be lethal turning into asphyxia [4].…”

Use of an Extended Working Channel in High-Risk Transbronchial Biopsy: An Innovative Use of an Existing Modality to Minimize Bleeding and Hypoxia

“…On the other hand, in a study by Kim et al of bronchoscopic procedures in 37 ventilated patients with thrombocytopenia, 2 patients died within 24 hours of procedure. 15,16 In our study, 15/105 (14.3%) patients had significant thrombocytopenia, some with additional risk factors ( Table 2). The average platelet count was 47,313/mm 3 (range: 31,000 to 73,000/ mm 3 ).…”

Safety of bronchoscopy in patients with malignant hematologic disorders

“…Weiss et al investigated bronchoscopies in 58 patients with thrombocytopenia and found complications in 7 (12%) but the complications were serious in only 1 patient [ 12 ]. Faiz et al surveyed 1711 bronchoscopies and found that platelet transfusion was performed in 90.6% of patients with platelet counts of < 10 × 10 3 /μl and 55.5% with platelet counts of 10 × 10 3 to < 20 × 10 3 /μl [ 13 ]. Bleeding occurred in 1.1% of the bronchoscopies but platelet transfusion did not significantly reduce the risk.…”