Introduction
Case presentation
Hemoglobin | 135 g/L |
White cell count | 10.3 × 10^12/L |
Neutrophils | 8.2 × 10^9/L |
Platelets | 318 × 10^9/L |
C-reactive protein | 132.9 mg/L |
Sodium | 130 mmol/L |
Potassium | 4.2 mmol/L |
Urea | 10.6 mmol/L |
Creatinine | 91 umol/L |
Albumin | 25 g/L |
Total protein | 68 g/L |
Lactate dehydrogenase | 258 U/L |
D-dimer | 2310 ng/mL |
APTT | 52 seconds |
INR | 1.2 |
pH | 7.8 |
Albumin | 14 g/L |
Total protein | 42 g/L |
Lactate dehydrogenase | 3570 U/L |
Glucose | <1.0 mmol/L |
Cytology | Mesothelial cells, macrophages and mixed inflammatory cells. No atypical or malignant cells. No micro-organisms seen |
Acid-fast bacilli not detected | |
Culture | Light growth of Staphylococcus aureus
|
Day 0 | Packed red blood cells | 21 |
Fresh frozen plasma | 17 | |
Platelets | 5 | |
Cryoprecipitate | 15 | |
Recombinant factor VII | 6.0 mg | |
Albumin 4 % | 1 | |
Day 1 | Packed red blood cells | 3 |
Fresh frozen plasma | 4 | |
Platelets | 1 | |
Day 2 | Packed red blood cells | 2 |
Fresh frozen plasma | 4 | |
Platelets | 2 | |
Day 3 | Packed red cells | 1 |
Day 4 | Packed red cells | 2 |
Study | Study type | Sample | Intrapleural therapy used | Anticoagulation or antiplatelet use | Hemorrhagic complications |
---|---|---|---|---|---|
Thommi et al. 2012 [11] | Single centre placebo controlled randomized controlled trial | 68 adults | Placebo or alteplase | Unspecified | Hemorrhage requiring transfusion in two patients |
Rahman et al. 2011 [5] | Multicentre placebo controlled randomized trial | 210 adults | Placebo or alteplase or DNase or alteplase + DNase | Unspecified | Two intrapleural hemorrhages and one hemoptysis in alteplase + DNase group. Two episodes of gastrointestinal bleeding in the DNase group. |
Maskell et al. 2005 [4] | Multi-centre placebo controlled randomized trial | 427 adults | Placebo or streptokinase | Unspecified | Seven hemorrhages (local or systemic) in streptokinase group, six in placebo group |
Nie et al. 2014 [10] | Meta-analysis of randomized trials | 879 adults, 98 children | Placebo, streptokinase, urokinase, tPA | Unspecified | Nonsignificant increase in severe side effects |
Piccolo et al. 2014 [13] | Retrospective observational study | 107 adults | tPA and DNase | Unfractionated heparin × 1, chronic liver disease and ↑prothrombin time × 1 | Hemorrhage requiring transfusion in two patients |
Anevlavis et al. 2011 [7] | Case series | Two adults | Alteplase | Therapeutic dose tinzaparin (14,000 IU), Prophylactic tinzaparin (3500 IU) | Two massive pleural hemorrhages |
Chai and Kuan, 2011 [17] | Case report | One adult | Streptokinase | Nil | Massive pleural hemorrhage |
Goralski et al. 2009 [9] | Case report and literature review | One adult | Alteplase | Nil | Severe pleural hemorrhage |
Gervais et al. 2008 [12] | Retrospective observational study | 66 adults | Alteplase | Warfarin × 1, low-molecular-weight heparin (dalteparin 5000U TDS) × 2, unfractionated heparin × 1 | Five major pleural hemorrhages in four patients who were anticoagulated. No hemorrhage in those receiving prophylactic anticoagulation or clopidogrel |
Ruiz et al. 2006 [8] | Case report | One adult | Alteplase | Nil | Massive pleural hemorrhage |