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Diffuse alveolar hemorrhage in allogeneic bone marrow transplantation. A postmortem study

C Agustí1, J Ramirez, C Picado

  • 1Department of Pathologic Anatomy, University of Barcelona, Spain.

American Journal of Respiratory and Critical Care Medicine
|April 1, 1995
PubMed
Summary
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Diffuse alveolar hemorrhage (DAH) is more common in patients with hematologic diseases undergoing allogeneic bone marrow transplant (BMT). DAH often co-occurs with other pulmonary complications in these high-risk patients.

Area of Science:

  • Pulmonary Medicine
  • Hematology
  • Transplantation Medicine

Background:

  • Diffuse alveolar hemorrhage (DAH) is a serious pulmonary complication.
  • Understanding DAH in patients with hematologic diseases is crucial, especially those undergoing bone marrow transplant (BMT).

Purpose of the Study:

  • To better define the syndrome of diffuse alveolar hemorrhage (DAH).
  • To investigate the incidence and associated pulmonary complications of DAH in patients with hematologic diseases, particularly those treated with allogeneic bone marrow transplant (BMT).

Main Methods:

  • Postmortem study of 77 patients with pulmonary complications.
  • Patients were divided into three groups: allogeneic BMT, conventional chemotherapy, and no hematologic disease.
  • DAH diagnosis required blood in at least 30% of lung tissue without other identifiable causes.

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Main Results:

  • DAH occurred in 23% of BMT patients (Group A) versus 5% of chemotherapy patients (Group B) (p < 0.05).
  • Of 11 DAH patients in Group A, 10 had associated pulmonary complications, including diffuse alveolar damage (DAD), bacterial pneumonia, invasive aspergillosis, CMV, and herpes pneumonia.
  • Bronchoscopy findings were inconsistent, with normal BAL fluid in 4 of 8 DAH patients and hemorrhagic BAL fluid in 7 of 13 non-DAH patients.

Conclusions:

  • Allogeneic bone marrow transplant (BMT) is associated with a higher incidence of diffuse alveolar hemorrhage (DAH).
  • DAH in BMT recipients frequently coexists with other pulmonary complications.
  • Clinical presentation and bronchoscopy findings may not reliably differentiate DAH in this patient population.