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

Area of Science:

• Pulmonology
• Hematology
• Interventional Pulmonology

Background:

• Bronchoscopy in thrombocytopenic patients is controversial due to undefined safe platelet thresholds.
• Invasive procedures like biopsies carry higher bleeding risks, especially in patients with low platelet counts.

Observation:

• A patient with thrombocytopenia underwent robotic-assisted bronchoscopy (RAB) for lung nodule sampling.
• A precautionary strategy involving thromboelastography (TEG) and segmental balloon occlusion was employed.

Findings:

• The combination of TEG and flexible bronchoscopy with balloon occlusion demonstrated a potentially safe method for RAB in thrombocytopenic patients.
• Absolute platelet count alone may not accurately predict bleeding risk during bronchoscopy.

Implications:

• This approach may offer a safer alternative for lung nodule sampling in high-risk thrombocytopenic patients.
• Further research is needed to establish definitive guidelines for bronchoscopy in thrombocytopenic individuals, incorporating functional hemostatic tests.