alveolar hemorrhage

Etiology

• immunologically mediated
  • Goodpasture's syndrome
  • glomerulonephritis
  • systemic lupus erythematosus
  • anticardiolipin antibody
• direct chemical or toxic injury
  • toxic or chemical inhalation
  • trimellitic anhydride
• pharmaceutical agents
  • mitomycin C
  • penicillamine
• physical trauma - pulmonary contusion
• increased pulmonary capillary pressure
  • mitral stenosis
  • severe left ventricular failure
• complication of lymphangiography
• pulmonary lymphangioleiomyomatosis (uncommon)
• pulmonary vaso-occlusive disease
• associated with history of heavy smoking
• associated with bone marrow transplantation

Pathology

• disruption of pulmonary capillary lining
• immunological & chemical mechanisms, trauma & increased pulmonary capillary pressure may contribute
• hemosiderin-laden macrophages

Clinical manifestations

• severity of symptoms dependent upon extent & acuteness of hemorrhage
• dyspnea
• anemia
• hemoptysis
• may be hematuria if associated with pulmonary-renal syndrome
• may be evidence of vasculitis

Laboratory

(frequent findings)

• complete blood count (CBC)
  • thrombocytopenia (< 50,000/mm3)
  • anemia
• coagulopathy
• serum creatinine > 2.5 mg/dL
  • may be related to platelet dysfunction associated with uremia

Diagnostic procedures

• bronchoalveolar lavage
  • hemosiderin-laden macrophages comprise > 20% of recovered alveolar macrophages
  • an increasing erythrocyte count from sequential bronchoalveolar lavage aliquots is diagnostic

Complications

• potentially fatal

Management

• cyclophosphamide may be of marginal benefit

More general terms

• pulmonary hemorrhage

Additional terms

• bronchoalveolar lavage (BAL)
• glomerulonephritis (GN, nephritic syndrome)
• Goodpasture's syndrome
• idiopathic pulmonary hemosiderosis (hemorrhage)
• left ventricular failure
• mitral stenosis (MS)
• pulmonary alveolus
• systemic lupus erythematosus
• trimellitic anhydride