C Agusti, J Ramirez, C Picado, A Xaubet, E Carreras, E Ballester, A Torres, C Battochia and R Rodriguez-Roisin
Department of Pathologic Anatomy, University of Barcelona, Spain.

To define better the syndrome of diffuse alveolar hemorrhage (DAH), we conducted a postmortem study in 77 patients who died of pulmonary complications, distributed into three groups. Group A included 47 patients with hematologic diseases treated with allogeneic bone marrow transplant (BMT); Group B, 20 patients with hematologic diseases treated with conventional chemotherapy; and Group C, 10 patients without hematologic diseases. The diagnosis of DAH was established when there was blood in at least 30% of the lung tissue evaluated without evidence of infection or any other pathologic change that could account for its presence. The presence of an associated pulmonary complication was considered only when there was normal lung parenchyma between both blood and the specific lesions. Diffuse alveolar hemorrhage was shown in 11 patients in Group A (23%) compared with 1 patient in Group B (5%) (p < 0.05). Of the 11 patients with DAH in Group A, 10 had some associated pulmonary complication: 7 presented with diffuse alveolar damage (DAD), 2 with associated bacterial pneumonia and 1 with invasive aspergillosis, 2 others had an associated cytomegalovirus (CMV) pneumonitis, and the remaining patients had an associated herpes pneumonia. There were no clinical differences between patients with and without DAH. Of 8 patients with confirmed DAH in Group A, who had been submitted to a bronchoscopic examination within 1 wk of death, 4 had normal BAL fluid; by contrast, 7 of 13 patients without DAH had hemorrhagic BAL fluid.(ABSTRACT TRUNCATED AT 250 WORDS)

This article has been cited by other articles:

				S. Sharma, H. F. Nadrous, S. G. Peters, A. Tefferi, M. R. Litzow, M.-C. Aubry, and B. Afessa Pulmonary Complications in Adult Blood and Marrow Transplant Recipients: Autopsy Findings Chest, September 1, 2005; 128(3): 1385 - 1392. [Abstract] [Full Text] [PDF]

				N. R. Patel, P.-S. Lee, J. H. Kim, G. L. Weinhouse, and H. Koziel The Influence of Diagnostic Bronchoscopy on Clinical Outcomes Comparing Adult Autologous and Allogeneic Bone Marrow Transplant Patients Chest, April 1, 2005; 127(4): 1388 - 1396. [Abstract] [Full Text] [PDF]

				R. M. Kotloff, V. N. Ahya, and S. W. Crawford Pulmonary Complications of Solid Organ and Hematopoietic Stem Cell Transplantation Am. J. Respir. Crit. Care Med., July 1, 2004; 170(1): 22 - 48. [Abstract] [Full Text] [PDF]

				R. Ben-Abraham, G. Paret, R. Cohen, O. Szold, G. Cividalli, A. Toren, and A. Nagler Diffuse Alveolar Hemorrhage Following Allogeneic Bone Marrow Transplantation in Children Chest, August 1, 2003; 124(2): 660 - 664. [Abstract] [Full Text] [PDF]

				B. Afessa, A. Tefferi, M. R. Litzow, M. J. Krowka, M. E. Wylam, and S. G. Peters Diffuse Alveolar Hemorrhage in Hematopoietic Stem Cell Transplant Recipients Am. J. Respir. Crit. Care Med., September 1, 2002; 166(5): 641 - 645. [Full Text] [PDF]

				D F Q C Yu and S R Desai Lung complications in patients undergoing bone marrow transplantation Imaging, August 1, 2002; 14(4): 272 - 277. [Abstract] [Full Text] [PDF]

				J. Heggen, C. West, E. Olson, T. Olson, G. Teague, J. Fortenberry, and A. M. Yeager Diffuse Alveolar Hemorrhage in Pediatric Hematopoietic Cell Transplant Patients Pediatrics, May 1, 2002; 109(5): 965 - 971. [Abstract] [Full Text] [PDF]

				I Khurshid and L C Anderson Non-infectious pulmonary complications after bone marrow transplantation Postgrad. Med. J., May 1, 2002; 78(919): 257 - 262. [Abstract] [Full Text] [PDF]

				A Rañó, C Agustí, P Jimenez, J Angrill, N Benito, C Danés, J González, M Rovira, T Pumarola, A Moreno, et al. Pulmonary infiltrates in non-HIV immunocompromised patients: a diagnostic approach using non-invasive and bronchoscopic procedures Thorax, May 1, 2001; 56(5): 379 - 387. [Abstract] [Full Text]

				C. Mayaud and J. Cadranel A persistent challenge: the diagnosis of respiratory disease in the non-AIDS immunocompromised host Thorax, June 1, 2000; 55(6): 511 - 517. [Full Text]

				M. A. JANTZ and S. A. SAHN Corticosteroids in Acute Respiratory Failure Am. J. Respir. Crit. Care Med., October 1, 1999; 160(4): 1079 - 1100. [Full Text]

				S. Nevo, V. Swan, C. Enger, K.J. Wojno, R. Bitton, M. Shabooti, A.K. Fuller, R.J. Jones, H.G. Braine, and G.B. Vogelsang Acute Bleeding After Bone Marrow Transplantation (BMT)--- Incidence and Effect on Survival. A Quantitative Analysis in 1,402 Patients Blood, February 15, 1998; 91(4): 1469 - 1477. [Abstract] [Full Text] [PDF]

				S. W. WILCZYNSKI, J. J. ERASMUS, W. P. PETROS, J. J. VREDENBURGH, and R. J. FOLZ Delayed Pulmonary Toxicity Syndrome following High-dose Chemotherapy and Bone Marrow Transplantation for Breast Cancer Am. J. Respir. Crit. Care Med., February 1, 1997; 157(2): 565 - 573. [Abstract] [Full Text]