Alveolar hemorrhage. Diagnostic criteria and results in 194 immunocompromised hosts.

Abstract

To establish the diagnosis of alveolar hemorrhage (AH) in cells recovered by bronchoalveolar lavage (BAL), Golde and colleagues created a score based on the hemosiderin content of alveolar macrophages stained with Prussian blue. We used an easier method, calculating the percentage of siderophages among the total alveolar macrophages recovered by BAL. We have retrospectively studied this method in 240 BALs performed in 194 immunocompromised patients. Prussian blue staining was performed on each BAL sample, and the Golde score was calculated for 47 samples chosen at random. The methods were compared for diagnosing AH. The percentage of siderophages correlated well with the Golde score. AH was defined by at least 20% siderophages. This definition was validated by comparison with the method of Kahn and coworkers. AH was present in 87 (36%) of the samples and was significantly associated with four parameters: thrombocytopenia (< 50,000/mm3), other abnormal coagulation parameters, renal failure (creatinine > or = 2.5 mg/dl), and a history of heavy smoking. The diagnosis of AH did not correlate with either the cause or the outcome of pneumonia. AH was seen more frequently in cardiac transplant patients (75%). In our experience, (1) a percentage of siderophages > or = 20% is sufficient and is an easier determinant of the diagnosis of AH than the Golde score; and (2) AH is rarely the sole cause of lung injury and is usually associated with other causes of pneumonia. AH may be considered more as a sign than as a distinct disease in this population.

Outcome of alveolar hemorrhage in hematopoietic stem cell transplant recipients

“…Smokers may have an elevated number of hemosiderinladen macrophages and as such, using X20% hemosiderinladen macrophages as the cutoff, decreases false-positive results. 11,26 The bronchoscopic criteria used to diagnose DAH are nonspecific and may be seen in association with diffuse lung injury from a wide variety of causes including engraftment syndrome, idiopathic pneumonia syndrome, sepsis, etc. In the post-HSCT setting, DAH syndrome is a retrospective diagnosis.…”

Hemorragia pulmonar secundaria a una reactivación tardía de un síndrome de Churg-Strauss en un paciente en hemodiálisis crónica: Report of one case

“…Si bien no es posible descartar que la hemorragia se haya originado en el sangrado de sus bronquiectasias, secuelas de la infección respiratoria sufrida durante la hemorragia cerebral o de su vasculitis, la rápida respuesta a la terapia inmunosupresora hace sugerente de que el origen de la hemorragia fue pulmonar. La capilaritis ha sido descrita también en enfermedades autoinmunes como lupus eritematoso, artritis reumatoide, polimiositis, enfermedad de Goodpasture, granulomatosis de Wegener, poliangeítis microscópica, púrpura de Henoch-Schoenlein, crioglobulinemia, enfermedad de Behçet, esclerodermia, enfermedad mixta del tejido conjuntivo y el síndrome antifosfolípido [17][18][19][20][21][22] . La etiología de la úlcera pilóri-ca que provocó su muerte no pudo establecerse dado que no se biopsió.…”

Diffuse Alveolar Hemorrhage in Acute Myeloid Leukemia

“…3 Idiopathic pneumonia syndrome has been described in patients following HSCT, typically within the first 6 months after transplantation. 2,8 This syndrome is associated with symptoms and signs of pneumonia and widespread alveolar injury despite the absence of infection, cardiac dysfunction, renal failure, or iatrogenic fluid. 2,8 Indeed, this expansive definition encompasses a variety of disorders, and DAH following HCST and engraftment syndrome have both been considered subset classifications of idiopathic pneumonia syndrome.…”

“…2,8 Indeed, this expansive definition encompasses a variety of disorders, and DAH following HCST and engraftment syndrome have both been considered subset classifications of idiopathic pneumonia syndrome. 8 …”