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alveolar hemorrhage
Etiology:
1) immunologically mediated
a) Goodpasture's syndrome
b) glomerulonephritis
c) systemic lupus erythematosus
d) anticardiolipin antibody
2) direct chemical or toxic injury
a) toxic or chemical inhalation
b) trimellitic anhydride
3) pharmaceutical agents
a) mitomycin C
b) penicillamine
4) physical trauma - pulmonary contusion
5) increased pulmonary capillary pressure
a) mitral stenosis
b) severe left ventricular failure
6) complication of lymphangiography
7) pulmonary lymphangioleiomyomatosis (uncommon)
8) pulmonary vaso-occlusive disease
9) associated with history of heavy smoking
10) associated with bone marrow transplantation [2]
Pathology:
1) disruption of pulmonary capillary lining
2) immunological & chemical mechanisms, trauma & increased pulmonary capillary pressure may contribute
3) hemosiderin-laden macrophages
Clinical manifestations:
1) severity of symptoms dependent upon extent & acuteness of hemorrhage
2) dyspnea
3) anemia
4) hemoptysis
5) may be hematuria if associated with pulmonary-renal syndrome
6) may be evidence of vasculitis
Laboratory: (frequent findings)
1) complete blood count (CBC)
- thrombocytopenia (< 50,000/mm3)
- anemia
2) coagulopathy
3) serum creatinine > 2.5 mg/dL
- may be related to platelet dysfunction associated with uremia
Special laboratory:
- bronchoalveolar lavage
- hemosiderin-laden macrophages comprise > 20% of recovered alveolar macrophages
Complications:
- potentially fatal
Management:
- cyclophosphamide may be of marginal benefit [3]
Related
bronchoalveolar lavage (BAL)
glomerulonephritis (GN, nephritic syndrome)
Goodpasture's syndrome
idiopathic pulmonary hemosiderosis (hemorrhage)
left ventricular failure
mitral stenosis (MS)
pulmonary alveolus
systemic lupus erythematosus
trimellitic anhydride
General
pulmonary hemorrhage
References
- Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed)
Lippincott-Raven, Philadelphia, 1998, pg 784-86
- Medical Knowledge Self Assessment Program (MKSAP) 14, 17
American College of Physicians, Philadelphia 2006, 2015
- Martinez-Martinez MU, Abud-Mendoza C.
Predictors of mortality in diffuse alveolar haemorrhage
associated with systemic lupus erythematosus.
Lupus. 2011 May;20(6):568-74
PMID: 21558137
- Lara AR, Schwarz MI.
Diffuse alveolar hemorrhage.
Chest. 2010 May;137(5):1164-71.
PMID: 20442117 Review.