Fungal Infections

Embolisation of the bronchial artery

Coughing up blood (haemoptysis) is a frightening symptom, and may be serious although often it is trivial. Haemoptysis is classified as mild, moderate and severe (massive). On definition is this:

•         Massive haemoptysis  >300ml blood/24 hours

•         Moderate  >3 episodes of 100ml/day/week

•         Mild   <100ml/day

The management of mild haemoptysis is usually reassurance and investigation. While barely studied, tranexamic acid (usually given orally) can arrest haemoptysis. A typical dose is 500-1000mg three times daily, for 5-7 days. Caution is required in older patients because it promotes clotting. It is useful for mild and moderate haemoptysis, but less so for massive haemoptysis. The side effect profile of tranexamic acid is shown in the table below.

Massive haemoptysis requires immediate admission to hospital, humidified oxygen and maintaining the patient upright. Ice compression over the affected area of the chest may allow contribute to bronchial and intercostal artery arterial vasoconstriction. Tranexamic acid and octreotide infusion (50-100μg/hour up to 2 days). An alternative is terlipressin (2mg iv 4hrly up to 72 hours). Blood transfusion is also usually necessary. Early angiography and embolisation (or emergency surgical resection) are then required, once the patient is partially stabilised. Massive haemoptysis is an unpredictable disease and rapid interventions are required.

Side effects of tranexamic acid

Common

Uncommon

Very uncommon

Rare

vomiting

giddiness

colour vision problems

thromboembolic events

nausea

psychiatric disturbances

hypotension on rapid IV infusion

visual impairment

diarrhoea

restlessness

thrombocytopenia

skin rashes

abdominal pain

 

abnormal bleeding times

retinopathy

 

 

coagulation defects

acute renal cortical necrosis

 

 

hydrocephalus

thromboembolism

 

 

intravesicular blood clotting

myocardial infarction

 

 

 

pulmonary embolism

 

 

 

cerebral ischemia

 

 

 

central venous stasis retinopathy

 

 

 

headaches

 

 

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