Safety of bronchoscopy in patients with malignant hematologic disorders

Safety of Bronchoalveolar Lavage in Hematological Patients with Thrombocytopenia. A Retrospective Cohort Study

Background

Hospitalized hematological patients often require bronchoalveolar lavage (BAL). Scarce evidence exists regarding the potential risks in patients with very severe thrombocytopenia (VST).

Methods

This retrospective-cohort study included adult hematological in-patients with VST, defined as platelets<20x103/μL, undergoing BAL during 2012-2021. Mechanically ventilated patients or those with known active bleeding were excluded. Primary outcomes included major bleeding halting the BAL or deemed significant by the treating physician, need for any respiratory support other than low flow O2, or death within 24 hours. Any other bleedings were recorded as secondary outcomes.

Results

Of the 507 patients included in the final analysis, the 281 patients with VST had lower hemoglobin (Md=0.3, p=0.003), longer prothrombin-time (Md=0.7s, p=0.025), higher chances of preprocedural platelet transfusion (RR 3.68, 95%CI [2.86,4.73]), and only one primary-outcome event (death of septic shock 21h postprocedurally) - compared with 3 (1.3%) events (two bleedings halting procedure and one need for non-invasive-ventilation) in patients with platelets ≥20x103/μL (p=0.219). The risk of minor spontaneously resolved bleeding was higher (RR=3.217, 95% CI [0.919,11.262]) in patients with VST (4.3% vs 1.3%, p=0.051). No association was found between the complications recorded and preprocedural platelets, age, aPTT, P.T., hematological status, or platelet transfusion.

Conclusions

This data suggests BAL to be safe even when platelet counts are <20x103/μL.

Two autopsy cases of pulmonary leukemic infiltration mimicking severe pneumonia in patients with acute myeloid leukemia

•

Diverse pulmonary complications are often observed in acute myeloid leukemia.

•

Clinically significant leukemic infiltration is rarely recognized antemortem.

•

Autopsy revealed leukemic infiltration in patient mimicking severe pneumonia.

•

It may be difficult to achieved accurate diagnosis without pathological examination.

•

Non-invasive examinations for leukemic infiltration diagnosis are required.

Although a previous autopsy series demonstrated that pulmonary leukemic infiltration (PLI) is a major pulmonary complication in patients with acute myeloid leukemia (AML), an antemortem diagnosis of PLI is rare. Diverse pulmonary complications cause acute respiratory failure (ARF) in patients with AML undergoing chemotherapy. This article reports two elderly patients with AML who presented with ARF due to PLI mimicking severe pneumonia during induction chemotherapy. Accurate antemortem diagnosis of PLI was almost impossible without pathological examination since the clinical course was not typical of PLI. We recommend considering PLI in patients with AML who have an unknown etiology of ARF.

The hemorrhage risk of patients undergoing bronchoscopic examinations or treatments

BACKGROUND

In recent years, bronchoscopic procedures have become more complex and sophisticated, as well as more extensively used. This study aimed to evaluate the safety, particularly the hemorrhage risk, of patients undergoing bronchoscopic examinations or treatments.

METHODS

This retrospective study consisted of inpatients and outpatients who underwent bronchoscopic examinations or treatments in our respiratory department between January 1, 2008 and December 31, 2019. We collected and analyzed the patient and bronchoscopic data.

RESULTS

Among the 45,734 patients who underwent diagnostic or therapeutic bronchoscopies, the severe complication rate was 0.85%, and the mortality was 0.01%. The severe complication rates varied significantly among the types of bronchoscopic procedures; the rate was higher with therapeutic bronchoscopies than with exploratory examination or biopsy bronchoscopies. Bleeding was the most common severe complication, and it occurred more frequently with biopsies in the left upper lobe and the bronchus intermedius, but its incidence decreased as the number of biopsies increased above one.

CONCLUSIONS

Although bronchoscopic procedures have become more complex and sophisticated, bronchoscopies are still well tolerated. However, precautions should be taken because hemorrhaging and pneumothorax remain potential complications, and they can be fatal.