To study the incidence and severity of endobronchial bleeding during Transbronchial lung biopsy (TBLB) procedure in patients without known clinical risk factors for increased bleeding: A Prospective observational study.

Transbronchial lung biopsy (TBLB) is performed duringflexible bronchoscopy in order to sample tissues. It is useful in patients withlocalized lung lesions, fungal or mycobacterial infections and in lungmalignancy. Although the procedure is relatively safe, complications such aspneumothorax and hemorrhage have been reported following TBLB. Currentguidelines do   not recommend routinepre-procedural studies of coagulation parameters, unless they are known or arelikely to have coagulation abnormalities. However, in CMC, we routinely screenall our patients. It is believed that it would result in reduction of bleedingrisk, but there is no evidence to support this practice.  Therefore, we want to assess if our protocolfor routine screening is providing added benefit to the patients in decreasingthe post procedural bleeding.

For our study, we intend to identify patients with knownclinical risk factors for increased bleeding and follow the recommendedprotocol of screening them for coagulation abnormalities, and if present andwhen required, to obtain clearance for procedure from the clinicalhematologists prior to the procedure. If recommended, they will be given bloodproducts prior to the procedure. These patients will be excluded from our study.

The patients who do nothave clinical risk factors will be recruited. Coagulation parameters will   be measured in these subjects. Theprocedures in these patients will be monitored and measurement of bleeding and all other relevant variables will beobtained. The physician doing the bronchoscopy procedure will be blinded to coagulationparameters of both arms. The amount of bleeding will be quantified (in grams/dlof Hemoglobin) as well as interpreted as mild,moderate and severe bleeding by the bronchoscopist. The frequency and quantity of bleed in group of patientswith abnormal bleeding parameters will be compared with those with normalbleeding parameters.We will also look forother possible etiological causes of increase risk of bleeding like PulmonaryHypertension, history of Aspirin intake, Vasculitis, Cavitating lesions, SVCsyndrome, multiple biopsies from 1 to 3 segment vs more than 3 segments, 3 to 5biopsy pieces versus more than 5 biopsy pieces etc.