Transbronchial lung biopsy (TBLB) is performed during flexible bronchoscopy in order to sample tissues. It is useful in patients with localized lung lesions, fungal or mycobacterial infections and in lung malignancy. Although the procedure is relatively safe, complications such as pneumothorax and hemorrhage have been reported following TBLB. Current guidelines do   not recommend routine pre-procedural studies of coagulation parameters, unless they are known or are likely to have coagulation abnormalities. However, in CMC, we routinely screen all our patients. It is believed that it would result in reduction of bleeding risk, but there is no evidence to support this practice.  Therefore, we want to assess if our protocol for routine screening is providing added benefit to the patients in decreasing the post procedural bleeding.

For our study, we intend to identify patients with known clinical risk factors for increased bleeding and follow the recommended protocol of screening them for coagulation abnormalities, and if present and when required, to obtain clearance for procedure from the clinical hematologists prior to the procedure. If recommended, they will be given blood products prior to the procedure. These patients will be excluded from our study.

The patients who do not have clinical risk factors will be recruited. Coagulation parameters will   be measured in these subjects. The procedures in these patients will be monitored and measurement of bleeding and all other relevant variables will be obtained. The physician doing the bronchoscopy procedure will be blinded to coagulation parameters of both arms. The amount of bleeding will be quantified (in grams/dl of Hemoglobin) as well as interpreted as mild, moderate and severe bleeding by the bronchoscopist. The frequency and quantity of bleed in group of patients with abnormal bleeding parameters will be compared with those with normal bleeding parameters.We will also look for other possible etiological causes of increase risk of bleeding like Pulmonary Hypertension, history of Aspirin intake, Vasculitis, Cavitating lesions, SVC syndrome, multiple biopsies from 1 to 3 segment vs more than 3 segments, 3 to 5 biopsy pieces versus more than 5 biopsy pieces etc.