Management of diffuse alveolar hemorrhage in the hematopoietic stem cell transplantation population: A systematic review

Abstract

Pulmonary complications post-hematopoietic stem cell transplantation (HSCT) such as diffuse alveolar hemorrhage (DAH) can occur in 2%-14% of HSCT patients with a mortality greater than 80%. [1][2][3][4] It is described as a syndrome of acute respiratory failure characterized by diffuse bilateral infiltrates and progressive hemorrhage and manifests as bleeding in the alveolar space due to injury to the alveolar-capillary basement membrane. 4,5 Clinical symptoms include cough, hypoxemia, and fever. [1][2][3][4] Imaging findings, either by x-ray or

Diffuse alveolar hemorrhage: a narrative review

“…Several patients present with hypoxemic respiratory failure, which may lead to death. [1][2][3][4][5][6][7] Hemoptysis may be present for as little as a few hours leading to a few days, approximately one third of patients do not present with hemoptysis. 1,2 Clinical presentation of DAH may be repetitive, acute, or subacute, and severity level may vary.…”

“…[1][2][3][4][5][6][7] Hemoptysis may be present for as little as a few hours leading to a few days, approximately one third of patients do not present with hemoptysis. 1,2 Clinical presentation of DAH may be repetitive, acute, or subacute, and severity level may vary. 1 Consequently, DAH should be contemplated in patients who present unexplained alveolar infiltrates.…”

“…1,2 Clinical presentation of DAH may be repetitive, acute, or subacute, and severity level may vary. 1 Consequently, DAH should be contemplated in patients who present unexplained alveolar infiltrates. Underlying systemic symptoms may or may not be present but occur within one of the following categories: DAH without systemic symptoms and signs or DAH with associated signs and systemic symptoms.…”

“…In situations when DAH is considered but no suggestive findings are present, the following conditions should be considered: pulmonary limited MPA, anti-GBM disease, idiopathic pulmonary hemosiderosis, pauci-immune isolated pulmonary capillaritis. 1,2 In cases of DAH with associated signs and systemic symptoms, the following indications from the patient's clinical history should intensify suspicion of DAH: acute glomerulonephritis, recent infection suggestive of vasculitis, particular use of offending drugs such as D-penicillamine, anticoagulants, cocaine, nitrofurantoin, amiodarone, propylthiouracil, or sirolimus, systemic vasculitis, mitral valve disease, CVD, and stem cell or organ transplant. [1][2][3][4][5][6][7]…”

“…DAH recognition requires bronchial alveolar lavage via bronchoscopy and pulmonary function may be done in patients who meet criteria. 1 Radiographic imaging is also non-specific due to it may represent other acute alveolar processes. The main clinical symptom is hemoptysis and may not be present in one-third of patients.…”