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Updated: May 17, 2026
Detection of Invasive Pulmonary Aspergillosis in Haematological Malignancy Patients by using Lateral-flow Technology
Published on: March 22, 2012
Successful non-standard approaches to massive hemoptysis in invasive pulmonary aspergillosis
Mirjana Mitrović1, Ivo Elezović, Nada Suvajdzić-Vuković
1Clinic of Hematology, Clinical Center of Serbia, Belgrade, Serbia. mmg@beotel.net
Introduction:
Invasive pulmonary aspergillosis (IA) is the most frequent invasive fungal infection in patients with hematological malignancies. Massive hemoptysis (MH) with blood loss more than 300-600 ml in 24 hours is a rare (5-10% of IA patients) but frequently fatal complication. Standard treatment of MH, such as oxygenation, a semi-sitting position with the bleeding site down, bronchoscopical suctioning, antifungal therapy, transfusion support and surgical resection might be either ineffective or not feasible in some cases.
Outline Of Cases:
We report two patients with life threatening, non-controlled, massive hemoptysis who were successfully managed by non-standard measures. A 61-year-old male with acute myeloid leukemia developed pulmonary IA and massive hemoptysis after consolidation cure by chemotherapy. The bleeding site was localized in the VI lung segment by bronchoscopy. Local application of fibrinogen-thrombin concentrate (fibrin glue) stopped the bleeding. A 22-year-old female patient with the diagnosis of severe aplastic anemia developed IA and massive hemoptysis early after application of immunosuppressive therapy (antilymphocyte globulin, cyclosporine and corticosteroids). Conventional transfusion therapy, desmopresine and antifibrinolytics were ineffective. This urgent condition was successfully treated with human activated recombinant factor VII (rFVIIa, NovoSeven).
Conclusion:
Our experience together with data from the available literature suggests a potential benefit of fibrinogen-thrombin concentrate and rFVIIa in the treatment of refractory critical bleeding in hemato-oncological patients.
Insights
Massive hemoptysis in hematological patients can be life-threatening. Fibrinogen-thrombin concentrate and recombinant factor VIIa offer novel, effective treatments for refractory bleeding, improving outcomes in invasive pulmonary aspergillosis cases.
Area of Science:
- Hematology
- Pulmonology
- Mycology
Background:
- Invasive pulmonary aspergillosis (IA) is a frequent infection in hematological malignancy patients.
- Massive hemoptysis (MH) is a rare but often fatal complication of IA.
- Standard MH treatments may be ineffective or not feasible.
Observation:
- Two cases of life-threatening, uncontrolled massive hemoptysis in IA patients are presented.
- One patient with acute myeloid leukemia received local fibrinogen-thrombin concentrate (fibrin glue).
- Another patient with aplastic anemia was treated with human activated recombinant factor VIIa (rFVIIa).
Findings:
- Fibrinogen-thrombin concentrate successfully controlled bleeding in the first patient.
- rFVIIa effectively managed refractory bleeding in the second patient after conventional therapies failed.
- Both non-standard treatments proved successful in critical bleeding scenarios.
Implications:
- Fibrinogen-thrombin concentrate and rFVIIa show potential benefits for refractory bleeding in hemato-oncological patients.
- These agents offer alternative therapeutic options when standard treatments are insufficient.
- Further research into these novel treatments for critical bleeding is warranted.
