Successful non-standard approaches to massive hemoptysis in invasive pulmonary aspergillosis
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 t...
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Serbian Medical Society
2012-01-01
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Online Access: | http://www.doiserbia.nb.rs/img/doi/0370-8179/2012/0370-81791208505M.pdf |
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doaj-1c413c8e5d724ce79419bed75a9e55f72021-01-02T02:11:10ZengSerbian Medical SocietySrpski Arhiv za Celokupno Lekarstvo0370-81792012-01-011407-850550710.2298/SARH1208505MSuccessful non-standard approaches to massive hemoptysis in invasive pulmonary aspergillosisMitrović MirjanaElezović IvoSuvajdžić-Vuković NadaAntić DarkoIntroduction. 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.http://www.doiserbia.nb.rs/img/doi/0370-8179/2012/0370-81791208505M.pdfinvasive pulmonary aspergillosismassive hemoptysisrFVIIafibrinogen-thrombin concentrate |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Mitrović Mirjana Elezović Ivo Suvajdžić-Vuković Nada Antić Darko |
spellingShingle |
Mitrović Mirjana Elezović Ivo Suvajdžić-Vuković Nada Antić Darko Successful non-standard approaches to massive hemoptysis in invasive pulmonary aspergillosis Srpski Arhiv za Celokupno Lekarstvo invasive pulmonary aspergillosis massive hemoptysis rFVIIa fibrinogen-thrombin concentrate |
author_facet |
Mitrović Mirjana Elezović Ivo Suvajdžić-Vuković Nada Antić Darko |
author_sort |
Mitrović Mirjana |
title |
Successful non-standard approaches to massive hemoptysis in invasive pulmonary aspergillosis |
title_short |
Successful non-standard approaches to massive hemoptysis in invasive pulmonary aspergillosis |
title_full |
Successful non-standard approaches to massive hemoptysis in invasive pulmonary aspergillosis |
title_fullStr |
Successful non-standard approaches to massive hemoptysis in invasive pulmonary aspergillosis |
title_full_unstemmed |
Successful non-standard approaches to massive hemoptysis in invasive pulmonary aspergillosis |
title_sort |
successful non-standard approaches to massive hemoptysis in invasive pulmonary aspergillosis |
publisher |
Serbian Medical Society |
series |
Srpski Arhiv za Celokupno Lekarstvo |
issn |
0370-8179 |
publishDate |
2012-01-01 |
description |
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. |
topic |
invasive pulmonary aspergillosis massive hemoptysis rFVIIa fibrinogen-thrombin concentrate |
url |
http://www.doiserbia.nb.rs/img/doi/0370-8179/2012/0370-81791208505M.pdf |
work_keys_str_mv |
AT mitrovicmirjana successfulnonstandardapproachestomassivehemoptysisininvasivepulmonaryaspergillosis AT elezovicivo successfulnonstandardapproachestomassivehemoptysisininvasivepulmonaryaspergillosis AT suvajdzicvukovicnada successfulnonstandardapproachestomassivehemoptysisininvasivepulmonaryaspergillosis AT anticdarko successfulnonstandardapproachestomassivehemoptysisininvasivepulmonaryaspergillosis |
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