Bronchial artery embolization in the management of hemoptysis in patients with hematologic diseases: Feasibility and short-term efficacy

Background: Patients with hematologic diseases are frequently accompanied by coagulopathy; even a small amount of hemoptysis may worsen clinical outcomes compared to those with the similar severity of injury without coagulopathy. However, a few studies have included various hematologic conditions, and none of them were large series. Objectives: To evaluate the feasibility and short-term efficacy of bronchial artery embolization (BAE) in the management of hemoptysis in patients with hematologic diseases. Patients and Methods: This was a retrospective study of 25 patients with hematologic diseases who visited our interventional unit for the management of hemoptysis between 2009 and 2012. The clinical, laboratory, and radiographic data were retrospectively analyzed and we correlated clinical response with the amount of hemoptysis, coagulation condition, radiographic pattern, and bronchial artery hypertrophy. Results: The amount of hemoptysis was trivial in 13 patients (52 %), moderate in ten patients (40%), and massive in two patients (8%). Thirteen patients (52%) had coagulopathy (platelet count < 5 × 10⁴ µL and/or international normalized ratio (INR) > 1.5). Seventeen patients (68%) showed focal pulmonary hemorrhagic patterns and eight patients (32%) showed diffuse pulmonary hemorrhagic patterns. BAE provided complete clinical response in 21 out of 25 patients (84%). Complete clinical response was not correlated with the amount of hemoptysis, coagulation condition, radiographic pattern, or bronchial artery hypertrophy (P > 0.05). There was no significant difference in short-term survival between patients with coagulopathy and those without coagulopathy (P = 0.425), and between patients with focal hemorrhagic pattern and those with diffuse hemorrhagic pattern (P = 0.728). Conclusion: BAE in hematology patients was relatively efficient in controlling hemoptysis. The amount of hemoptysis, coagulation condition, radiographic pattern, or bronchial artery hypertrophy was not a significant factor affecting the outcome.