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Diffuse alveolar hemorrhage syndromes in children

Sarat C Susarla1, Leland L Fan

  • 1Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, 1102 Bates Street, Houston, TX 77030, USA. ssusarla@bcm.edu

Current Opinion in Pediatrics
|May 17, 2007
PubMed

Insights

Diffuse alveolar hemorrhage in children is increasingly recognized, including pulmonary capillaritis. Diagnosis may require lung biopsy, especially when serology is negative, guiding aggressive treatment for immune-mediated lung disease.

Area of Science:

  • Pediatric Pulmonology
  • Immunology
  • Critical Care Medicine

Background:

  • Diffuse alveolar hemorrhage (DAH) is a rare but serious condition in children.
  • Traditionally, idiopathic pulmonary hemosiderosis was the primary diagnosis, but the differential diagnosis is expanding.
  • Newer understanding includes immune-mediated causes like pulmonary capillaritis.

Purpose of the Study:

  • To review evolving concepts of DAH in children.
  • To discuss an expanded differential diagnosis for DAH.
  • To outline new diagnostic and treatment strategies for pediatric DAH.

Main Methods:

  • Review of current literature on pediatric diffuse alveolar hemorrhage.
  • Analysis of recent case reports and studies, including pediatric pulmonary capillaritis.
  • Discussion of diagnostic modalities and therapeutic approaches.

Main Results:

  • Pulmonary capillaritis, an immune-mediated DAH, is being increasingly reported in children.
  • Serological markers for immune-mediated disorders were positive in only half of pediatric pulmonary capillaritis cases.
  • Acute idiopathic pulmonary hemorrhage in infants remains of uncertain etiology.

Conclusions:

  • The classification of DAH in children now includes conditions with and without pulmonary capillaritis.
  • Lung biopsy is crucial for diagnosing DAH in children, particularly when cardiovascular causes are excluded and serology is negative.
  • Immune-mediated lung diseases necessitate more aggressive pharmacologic interventions.
Abstract

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