COMPLICATIONS OF FIBEROPTIC BRONCHOSCOPY IN THROMBOCYTOPENIC PATIENTS

Study objective: To determine the risk of epistaxis and pulmonary hemo rrhage due to fiberoptic bronchoscopy (FOB) and bronchoalveolar lavage (BAL) in the presence of thrombocytopenia. Design: Prospective study of all patients undergoing FOB with BAL with a 4.9-mm-diameter broncho scope after bone narrow transplantation (BMT) during a 6-month period. Setting: A single BMT center. Patients: Forty-seven BMT recipients un dergoing 66 FOB with BAL. Thrombocytopenia (platelets < 100,000/ml) wa s present in 58 (88 percent). Platelets were <50,000/ml in 44 (67 perc ent) and <20,000/ml in 13 (20 percent). In the thrombocytopenic patien ts, FOB with BAL was transnasal in 37 (64 percent), transoral in 5 (9 percent), and via endotracheal tube in 16 (28 percent). Interventions: Fiberoptic bronchoscopy with BAL using a bronchoscope (Pentax FB-15H) (4.9-mm diameter). In one case, a pediatric bronchoscope (Pentax FB-1 0H; 3.5-mm diameter) was used in a 7-year-old patient. Measurements an d results: The BAL was diagnostic in 22 of 47 patients studied (47 per cent). Complications occurred in 7 of 58 (12 percent) thrombocytopenic patients (epistaxis and/or hemoptysis, 4; bradycardia, 2; bronchospas m, 1) of which all but 1 were minor and self-limiting. One life-threat ening complication of severe epistaxis occurred during a transoral FOB in a patient with prior epistaxis (platelet count, 18,000/ml). One of 8 (13 percent) nonthrombocytopenic patients had hemoptysis. No patien t had worsening fever or oxygenation at 4 h and no patient displayed w orsening radiographic infiltrates suggestive of pulmonary hemorrhage a ttributable to the BAL at 24 h. Conclusions: We conclude that transnas al FOB in thrombocytopenic patients was safe, being associated with mi nor airway bleeding in 3 of 37 patients (8 percent). In conclusion, FO B with BAL, even via the transnasal route, may be performed with relat ive safety despite the presence of significant thrombocytopenia.