Diagnostic lavage and occult pulmonary hemorrhage in thrombocytopenic immunocompromised patients

Twenty consecutive thrombocytopenic immunocompromised patients with pulmonary infiltrates underwent diagnostic bronchopulmonary lavage. Nine patients were found to have occult pulmonary hemorrhage as evidenced by increased stainable hemosiderin within alveolar macrophages. Other diagnoses established included Pneumocystis carinii pneumonia in 2 patients and metastatic carcinoma in 1. No hemorrhage was precipitated by the procedure, even in 7 patients whose platelet counts were less than or equal to 20,000 per mm3. We concluded that bronchopulmonary lavage is a safe and effective diagnostic procedure in thrombocytopenic immunocompromised patients and that occult pulmonary hemorrhage is a common cause of diffuse pulmonary infiltrates in such patients.