Adequate volume replacement with crystalloids, followed by blood, should be given. In patients with cardio-respiratory impairment, titration against central venous pressure may be necessary. Replacement of platelets and clotting factors will be needed in some patients. Specific therapy will be dictated by the individual situation. Radiation therapy can be effective in stopping bleeding from most tumour sites. A short fractionated course, such as 20 Gy in five fractions, or even a single fraction of 8 Gy, can be given.
Endoscopic brachytherapy can be a useful tool, especially in patients previously treated by radiation. Bleeding can also be treated endo-scopically in accessible sites. Endoscopic sclerotherapy can sometimes be useful for bleeding from larger vessels; smaller vessel bleeding may respond to laser treatment with the Nd: YAG laser. In severe, recalcitrant cases, bronchial angiography and selective arterial embolization may be necessary.
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