Treatment and prognosis of massive hemoptysis in cystic fibrosis.

Massive hemoptysis (volume of expectorated blood > 300 ml in 24 hours) 
occurred in 38 (5 per cent) 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 2,500 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 lobectomoy at another hospital but continued to bleed 
postoperatively. Ten patients died (mean survival after hemoptysis, 2.5 years; range, 
3 months to 6 years). 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 months to 20 years after their initial episode. Our 
dat suggest that 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. 