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Dr Chapman's point is well taken. However, in addition to "inconvenience," one has to explain in detail to the patient the hazards of the procedure, emphasize its importance, and then risk magnifying the patient's anxiety by cancelling, at a very inopportune moment, a procedure that the patient now considers so important to his treatment. In addition, it is unlikely that Dr Chapman's approach would reduce by half the risk of transfusion, as most of these patients have received multiple transfusions of RBCs and platelets prior to the development of lung disease and continue to require platelet support for some time after the procedure. We have been tempted to use Dr Chapman's approach because of the one-day delay in diagnosis, but we have chosen a transfusion test the day prior to biopsy for these reasons.
Feldman NT, Pennington J. Transbronchial Lung Biopsy in the Compromised Host-Reply. JAMA. 1978;239(7):613. doi:10.1001/jama.1978.03280340033006
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