Extracorporeal life support for a 5-week-old infant with idiopathic pulmonary hemosiderosis

Abstract

Patients with severe pulmonary hemorrhage secondary to idiopathic pulmonary hemosiderosis can be safely supported with extracorporeal life support when conventional therapies have been exhausted.

Extracorporeal Membrane Oxygenation for Diffuse Alveolar Hemorrhage Caused by Idiopathic Pulmonary Hemosiderosis: A Case Report and a Review of the Literature

“…Bleeding complications were reported in two cases, that is, a mediastinal hemorrhage after a median sternotomy was reported in one case, 19 and transient exacerbation of alveolar hemorrhage in IPH was reported in the other case. 7 Bleeding was eventually controlled in both cases and the patients survived to decannulation. These findings suggest that ECMO may be strongly indicated for refractory respiratory failure caused by DAH unresponsive to maximal therapy.…”

“…As reported, 95% of patients were successfully decannulated from ECMO and 90% survived to discharge. To our knowledge, there are 26 published cases 6,7,[11][12][13][14][15][16][17][18][19][20][21][22][23] of DAH managed with ECMO in children, including our case (►Table 3). The most common etiology was IPH followed by a cardiac etiology.…”

“…10 To our knowledge, there are only two case reports of IPH successfully treated with ECMO. 6,7 While both cases were maintained by systemic heparin for anticoagulation, the DAH was successfully controlled with corticosteroid and the patients were weaned off ECMO without any bleeding complications. Extracorporeal membrane oxygenation for DAH treatment was first reported by Siden et al 11 in 1994 and an increasing number of cases successfully treated with ECMO are being reported both among adults and children.…”

“…5 However, only a few instances of DAH in children caused by IPH and treated with ECMO have been reported. 6,7 We report, herein, a case of an 8-year-old girl with severe respiratory failure caused by DAH who underwent ECMO.…”

Severe Respiratory Distress in a Child with Pulmonary Idiopathic Hemosiderosis Initially Presenting with Iron-Deficiency Anemia

“…It is commonly characterized by the triad of recurrent hemoptysis, diffuse parenchymal infiltrates, and iron-deficiency anemia [ 3 – 5 ]. Pathogenesis is unclear and diagnosis may be difficult due to a variable clinical course [ 5 , 6 ]. About 500 cases of this disease have been described in medical literature [ 5 , 7 ].…”