Bronchoscopy with transbronchial biopsies: measurement of bleeding volume and evaluation of the predictive value of coagulation tests

The objectives of this study were to measure the bleeding volume associated with fibreoptic bronchoscopy with transbronchial biopsies (TBB), to correl ate it with coagulation tests and to compare bleeding volume in patients wi th and without lung transplant. A total of 104 consecutive TBB in 51 different patients was evaluated prosp ectively, Before each procedure, haemoglobin, blood platelets, prothrombin time (PT), activated partial thromboplastin time (aPTT) and bleeding time w ere measured. During the procedure, lavage fluid and blood were collected b y suction. The haemoglobin concentration of the mixture was measured and bl eeding volume was calculated. Clinically significant bleeding was arbitrari ly defined as >20 mi, blood present in lavage fluid, The mean+/-SD bleeding volume was 7+/-10 mt with no statistically significa nt difference between transplanted and nontransplanted patients, In eight p rocedures (7.7%) the bleeding volume was >20 mt (range 22-61 mt). Prebiopsy values for blood platelet counts, PT and aPTT did not predict a bleeding t endency in any of the procedures in which significant bleeding occurred. No correlation was found between bleeding time and bleeding volume in the 17 procedures performed in patients with a prolonged bleeding time (greater th an or equal to 10 min), The bleeding associated with transbronchial biopsies was usually minor and quantitatively similar in patients with or without lung transplant, Coagula tion tests could not predict clinically significant bleeding, which may occ ur in patients with normal coagulation test results.