Respiratory Medicine CME
Volume 2, Issue 3 , Pages 144-146, 2009

Endobronchial application of Ankaferd blood stopper to control profuse lung bleeding leading to hypoxemia and hemodynamic instability

  • Sinan Arslan

      Affiliations

    • Department of Chest Disease, Derince State Hospital, Kocaeli, Turkey
    • ,
  • Ibrahim C. Haznedaroglu

      Affiliations

    • Department of Hematology, Hacettepe University Medical School, Sihhiye, 06100 Ankara, Turkey
    • Corresponding Author InformationCorresponding author. Tel.: +90 3123051543.
    • ,
  • Büge Öz

      Affiliations

    • Department of Pathology, Cerrahpasa Medical School, Istanbul, Turkey
    • ,
  • Hakan Goker

      Affiliations

    • Department of Hematology, Hacettepe University Medical School, Sihhiye, 06100 Ankara, Turkey

Received 12 September 2008; accepted 16 October 2008.

Article Outline

Keywords: Bleeding, Lung cancer, Ankaferd blood stopper®

 

Profuse lung bleeding caused by tumoral infiltration, a sudden clinically challenging emergent state, can cause life-threatening hypoxemia and hemodynamic instability.1 Ankaferd blood stopper (ABS) is a unique standardized medicinal plant extract, which has been approved in the management of post-surgery external bleeding and dental surgery in Turkey.2 ABS induces a very rapid formation (less than 1s) of a specific hemostatic protein network within vital erythroid aggregation in the injured vascular area.2 Data on the efficacy of ABS for the management of bleedings of difficult clinical states are limited to case reports only.3, 4, 5 We, herein, present a non-small cell lung cancer patient presenting with severe hemoptysis leading to hypoxemia and hemodynamic instability, which had successfully been controlled via the endoscopic application of ABS.

A 62-year-old man was admitted into the emergency room because of severe hemoptysis, hypoxemia, anemia and hemodynamic instability. Emergent fiberoptic bronchoscopy revealed that the right intermediate bronchus orifice was almost completely occluded by an actively bleeding endobronchial neoplastic lesion (Fig. 1A). Subsequent tissue biopsies were taken from the lesion and 2ml of ABS was administered topically to the bleeding mass because of the emergent life-threatening state, and hemostasis was achieved within seconds (Fig. 1B). No sign of bleeding was observed in the following days. The patient was hemodynamically stabilized. Histopathological appearance of the tissues after Ankaferd application is correlated to reveal that ABS does result in the formation of unique erythroid-rich aggregates within the eosinophilic protein network (Figure 2, Figure 3). Furthermore, poor-differentiated squamous cell carcinoma cells were trapped within the ABS-induced hemostatic network (Fig. 4).

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  • Figure 1 

    Fiberoptic bronchoscopy revealed that the right intermediate bronchus orifice was almost completely occluded by a bleeding neoplastic endobronchial lesion (A). Subsequent tissue biopsies were taken from the lesion and 2ml of ABS was administered topically to the bleeding mass, and hemostasis was achieved within seconds (B).

Lung bleedings may represent a real diagnostic and therapeutic challenge as in our patient. Effective management of the bleeding problem is particularly required in patients with hereditary and acquired hemorrhagic diathesis including neoplasia and the use of anticoagulant, antihemostatic drugs.6 ABS, a standardized mixture of five plants, provides immediate hemostasis. A study showed that its effect is not dependent on individual coagulation factors and platelets.2 Its hemostatic success in primary and secondary hemostatic defects has been supported with in vivo and in vitro observations.2, 3, 4, 5 Neither any local adverse effect nor systemic toxicity was observed following the bronchoscopic application of ABS. Therefore, physiological cell-based coagulation could be clinically managed via topical Ankaferd application to prevent and treat bleeding in many distinct clinicopathological states. Since there is a close correlation between tumor growth and hemostasis of cancer,7, 8 the effect of ABS among other hemostatic agents9 should also be further searched. Controlled clinical studies should be performed regarding the efficacy of ABS in the controlling of emergency bleedings.

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Conflict of interest statement 

None of the authors have a conflict of interest to declare in relation to this work.

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References 

  1. Hoffmann RT, Spelsberg F, Reiser MF. Lung bleeding caused by tumoral infiltration into the pulmonary artery – minimally invasive repair using microcoils. Cardiovasc Intervent Radiol. 2007;30:1282–1285
  2. Goker H, Haznedaroglu IC, Ercetin S, Kirazli S, Akman U, Ozturk Y, et al. Haemostatic actions of the folkloric medicinal plant extract Ankaferd blood stopper. J Int Med Res. 2008;36:163–170
  3. Kurt M, Disibeyaz S, Akdogan M, Sasmaz N, Aksu S, Haznedaroglu IC. Endoscopic application of Ankaferd blood stopper® as a novel experimental treatment modality for upper gastrointestinal bleeding: a case report. Am J Gastroenterol. 2008;103:2156–2158
  4. Kurt M, Kacar S, Onal IK, Akdogan M, Haznedaroglu IC. Ankaferd blood stopper® as an effective adjunctive hemostatic agent for the management of life-threatening arterial bleeding of the digestive tract. Endoscopy 2008 (in press).
  5. Ibis M, Kurt M, Onal IK, Haznedaroglu IC. Successful management of bleeding due to solitary rectal ulcer via topical application of Ankaferd blood stopper®. J Altern Complement Med 2008 (in press).
  6. Kadayifci A, Haznedaroglu IC, Savas MC. Risk of withdrawing chronic anticoagulation without antithrombotic prophylaxis. Am J Gastroenterol. 1997;92:361–362
  7. Im JH, Fu W, Wang H, Bhatia SK, Hammer DA, Kowalska MA, et al. Coagulation facilitates tumor cell spreading in the pulmonary vasculature during early metastatic colony formation. Cancer Res. 2004;64:8613–8619
  8. Unsal E, Atalay F, Atikcan S, Yilmaz A. Prognostic significance of hemostatic parameters in patients with lung cancer. Respir Med. 2004;98:93–98
  9. Mousa SA, Linhardt R, Francis JL, Amirkhosravi A. Anti-metastatic effect of a non-anticoagulant low-molecular-weight heparin versus the standard low-molecular-weight heparin, enoxaparin. Thromb Haemost. 2006;96:816–821

PII: S1755-0017(08)00101-2

doi:10.1016/j.rmedc.2008.10.016

Respiratory Medicine CME
Volume 2, Issue 3 , Pages 144-146, 2009

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