TREATMENT AND PROGNOSIS OF MASSIVE HEMOPTYSIS IN CYSTIC-FIBROSIS

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Abstract
Massive hemoptysis (volume of expectorated blood .gtoreq. 300 ml in 24 h) occurred in 38 (5%) of 728 patients with cystic fibrosis. Twenty-two of the patients were in the midst of a relatively long-lasting flare-up of pulmonary infection. There was no other consistent precipitating event. All but 7 of the patients were admitted after the initial episode and were treated with parenteral antimicrobial drugs. Postural drainage was resumed as rapidly as possible after cessation of acute bleeding. Vitamin K was administered to all patients. Volumes of expectorated blood were as large as 2500 ml with the initial episode. Blood pressure changes occurred in 4 patients. Five patients received blood transfusions. Bleeding stopped without surgical intervention in all patients, usually within 4 days. The 38 patients had a total of 85 episodes of bleeding. No surgical treatment was undertaken at this center. One patient underwent a lobectomy at another hospital but continued to bleed postoperatively. Ten patients died (mean survival after initial hemoptysis, 2.5 yr; range, 3 mo.-6 yr). This survival rate is comparable to that of another group of patients with equally severe lung disease who had never bled profusely. The other 28 patients remain alive from 7 mo.-20 yr after their initial episode. Massive hemoptysis complicating cystic fibrosis may not be as ominous an event as has been believed in the past. Because of the tendency of most patients to stop bleeding without aggressive surgical intervention, future studies of new therapeutic measures for massive hemoptysis must have appropriate untreated control patients who receive only medical management.

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