Introduction

Haematological abnormalities are common in patients referred for lung transplantation and are among the most frequently observed complications of transplant surgery and immunosuppressive treatment. This chapter provides an overview of the most important haematological aspects of lung transplantation.

Haematological abnormalities in patients referred for lung transplantation

Cystic fibrosis

Cystic fibrosis (CF) may be associated with liver disease [1], secondary hypersplenism and vitamin K deficiency [2, 3]. The former tends to be relatively uncommon in CF patients referred for lung transplantation, because of selection effects. (CF-related liver cirrhosis tends to develop before puberty [1], before major lung damage has had a chance to develop.) When present, liver disease may not be an absolute contraindication to isolated lung transplantation if the prothrombin time and other measures of hepatic synthetic function are normal [4]. Where liver and pulmonary function are both severely compromised, heart–lung–liver transplantation is an option [5].

Vitamin K is a fat-soluble vitamin required for synthesis of the procoagulant factors II, VII, IX and X. Deficiency of vitamin K may develop in CF because of pancreatic insufficiency, liver disease, inadequate dietary intake of the vitamin, or the effects of antibiotics on vitamin K synthesis by gut flora. The frequency of vitamin K deficiency in CF patients is unclear: some believe it to be common [2], while others believe it to be very uncommon [3]. In most vitamin K deficient patients, the prothromb in time and other haemostatic variables remain normal [2]; thus, any CF patient who develops unexplained bleeding should receive vitamin K therapy regardless of the results of routine coagulation tests.