Diffuse Alveolar Hemorrhage After Pediatric Hematopoietic Stem Cell Transplantation
Pulmonary complications are common following hematopoietic cell transplantation (HCT) and contribute significantly to its morbidity and mortality. Diffuse alveolar hemorrhage is a devastating non-infectious complication that occurs in up to 5% of patients post-HCT. Historically, it carries a high mo...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2020-09-01
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| Series: | Frontiers in Oncology |
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| Online Access: | https://www.frontiersin.org/article/10.3389/fonc.2020.01757/full |
| _version_ | 1819080848976117760 |
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| author | Kimberly Fan Jennifer McArthur R. Ray Morrison Saad Ghafoor |
| author_facet | Kimberly Fan Jennifer McArthur R. Ray Morrison Saad Ghafoor |
| author_sort | Kimberly Fan |
| collection | DOAJ |
| description | Pulmonary complications are common following hematopoietic cell transplantation (HCT) and contribute significantly to its morbidity and mortality. Diffuse alveolar hemorrhage is a devastating non-infectious complication that occurs in up to 5% of patients post-HCT. Historically, it carries a high mortality burden of 60–100%. The etiology remains ill-defined but is thought to be due to lung injury from conditioning regimens, total body irradiation, occult infections, and other comorbidities such as graft vs. host disease, thrombotic microangiopathy, and subsequent cytokine release and inflammation. Clinically, patients present with hypoxemia, dyspnea, and diffuse opacities consistent with an alveolar disease process on chest radiography. Diagnosis is most commonly confirmed with bronchoscopy findings of progressively bloodier bronchoalveolar lavage or the presence of hemosiderin-laden macrophages on microscopy. Treatment with glucocorticoids is common though dosing and duration of therapy remains variable. Other agents, such as aminocaproic acid, tranexamic acid, and activated recombinant factor VIIa have also been tried with mixed results. We present a review of diffuse alveolar hemorrhage with a focus on its pathogenesis and treatment options. |
| first_indexed | 2024-12-21T19:51:25Z |
| format | Article |
| id | doaj.art-2a57a1ffbf184d94a0468b221d6f22c2 |
| institution | Directory Open Access Journal |
| issn | 2234-943X |
| language | English |
| last_indexed | 2024-12-21T19:51:25Z |
| publishDate | 2020-09-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Oncology |
| spelling | doaj.art-2a57a1ffbf184d94a0468b221d6f22c22022-12-21T18:52:12ZengFrontiers Media S.A.Frontiers in Oncology2234-943X2020-09-011010.3389/fonc.2020.01757570220Diffuse Alveolar Hemorrhage After Pediatric Hematopoietic Stem Cell TransplantationKimberly Fan0Jennifer McArthur1R. Ray Morrison2Saad Ghafoor3Division of Pediatric Critical Care, University of Tennessee Health Science Center, Memphis, TN, United StatesDivision of Critical Care, St. Jude Children's Research Center, Memphis, TN, United StatesDivision of Critical Care, St. Jude Children's Research Center, Memphis, TN, United StatesDivision of Critical Care, St. Jude Children's Research Center, Memphis, TN, United StatesPulmonary complications are common following hematopoietic cell transplantation (HCT) and contribute significantly to its morbidity and mortality. Diffuse alveolar hemorrhage is a devastating non-infectious complication that occurs in up to 5% of patients post-HCT. Historically, it carries a high mortality burden of 60–100%. The etiology remains ill-defined but is thought to be due to lung injury from conditioning regimens, total body irradiation, occult infections, and other comorbidities such as graft vs. host disease, thrombotic microangiopathy, and subsequent cytokine release and inflammation. Clinically, patients present with hypoxemia, dyspnea, and diffuse opacities consistent with an alveolar disease process on chest radiography. Diagnosis is most commonly confirmed with bronchoscopy findings of progressively bloodier bronchoalveolar lavage or the presence of hemosiderin-laden macrophages on microscopy. Treatment with glucocorticoids is common though dosing and duration of therapy remains variable. Other agents, such as aminocaproic acid, tranexamic acid, and activated recombinant factor VIIa have also been tried with mixed results. We present a review of diffuse alveolar hemorrhage with a focus on its pathogenesis and treatment options.https://www.frontiersin.org/article/10.3389/fonc.2020.01757/fulldiffuse alveolar hemorrhagehematopoietic cell transplant (HCT) complicationspediatric oncologyglucocorticoidsthrombotic microangiopathygraft vs. host disease |
| spellingShingle | Kimberly Fan Jennifer McArthur R. Ray Morrison Saad Ghafoor Diffuse Alveolar Hemorrhage After Pediatric Hematopoietic Stem Cell Transplantation Frontiers in Oncology diffuse alveolar hemorrhage hematopoietic cell transplant (HCT) complications pediatric oncology glucocorticoids thrombotic microangiopathy graft vs. host disease |
| title | Diffuse Alveolar Hemorrhage After Pediatric Hematopoietic Stem Cell Transplantation |
| title_full | Diffuse Alveolar Hemorrhage After Pediatric Hematopoietic Stem Cell Transplantation |
| title_fullStr | Diffuse Alveolar Hemorrhage After Pediatric Hematopoietic Stem Cell Transplantation |
| title_full_unstemmed | Diffuse Alveolar Hemorrhage After Pediatric Hematopoietic Stem Cell Transplantation |
| title_short | Diffuse Alveolar Hemorrhage After Pediatric Hematopoietic Stem Cell Transplantation |
| title_sort | diffuse alveolar hemorrhage after pediatric hematopoietic stem cell transplantation |
| topic | diffuse alveolar hemorrhage hematopoietic cell transplant (HCT) complications pediatric oncology glucocorticoids thrombotic microangiopathy graft vs. host disease |
| url | https://www.frontiersin.org/article/10.3389/fonc.2020.01757/full |
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