Srpski arhiv za celokupno lekarstvo 2012 Volume 140, Issue 7-8, Pages: 505-507
https://doi.org/10.2298/SARH1208505M
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Successful non-standard approaches to massive hemoptysis in invasive pulmonary aspergillosis
Mitrović Mirjana (Klinika za hematologiju, Klinički centar Srbije, Beograd)
Elezović Ivo (Klinika za hematologiju, Klinički centar Srbije, Beograd + Medicinski fakultet, Beograd)
Suvajdžić-Vuković Nada (Klinika za hematologiju, Klinički centar Srbije, Beograd + Medicinski fakultet, Beograd)
Antić Darko (Klinika za hematologiju, Klinički centar Srbije, Beograd + Medicinski fakultet, Beograd)
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
hematooncological patients.
Keywords: invasive pulmonary aspergillosis, massive hemoptysis, rFVIIa, fibrinogen-thrombin concentrate