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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
Summary
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.
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