Diffuse alveolar hemorrhage in autologous bone marrow transplant recipients

Richard A. Robbins, James Linder, Marlin G. Stahl, Austin Bassett Thompson, William Haire, Anne Kessinger, James Olen Armitage, Mark Arneson, Gail Woods, William P. Vaughan, Stephen I. Rennard

Research output: Contribution to journalArticle

175 Citations (Scopus)

Abstract

Purpose: The purpose of our work was to evaluate pulmonary complications in autologous bone marrow transplant recipients. Patients and methods: A total of 141 consecutive autologous bone marrow transplant recipients were evaluated. In 29 patients, a clinical syndrome characterized by progressive dyspnea, hypoxia, cough, diffuse consolidation on chest roentgenography, and characteristic bronchoalveolar lavage findings developed over one to seven days. Results: In 29 patients, bronchoalveolar lavage performed by sequential instillation and aspiration of 20-ml aliquots of normal saline resulted in recovered lavage fluid that became progressively bloodier with each recovered aliquot. Autopsy and bronchoalveolar lavage m these patients revealed no pathogens that accounted for the clinical findings. Since the later aliquots sample predominantly alveolar material, this syndrome was termed diffuse alveolar hemorrhage (DAH). DAH was associated with a high inpatient mortality rate (23 of 29 died versus 14 of 112 without DAH, p < 0.001) and was associated with age over 40 years, solid malignancies, high fevers, severe mucositis, white blood cell recovery, and renal insufficiency (p <0.05, compared with patients without DAH). However, DAH was not associated with prolonged prothrombin or partial thromboplastin times or decreased platelet counts compared with patients without DAH. Conclusion: DAH is a frequent cause of respiratory compromise and a major cause of mortality in autologous bone marrow transplant recipients.

Original languageEnglish (US)
Pages (from-to)511-518
Number of pages8
JournalThe American journal of medicine
Volume87
Issue number5
DOIs
StatePublished - Nov 1989

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Bone Marrow
Hemorrhage
Bronchoalveolar Lavage
Mucositis
Partial Thromboplastin Time
Mortality
Therapeutic Irrigation
Prothrombin
Transplant Recipients
Platelet Count
Cough
Radiography
Dyspnea
Renal Insufficiency
Inpatients
Autopsy
Leukocytes
Fever
Thorax
Lung

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Diffuse alveolar hemorrhage in autologous bone marrow transplant recipients. / Robbins, Richard A.; Linder, James; Stahl, Marlin G.; Thompson, Austin Bassett; Haire, William; Kessinger, Anne; Armitage, James Olen; Arneson, Mark; Woods, Gail; Vaughan, William P.; Rennard, Stephen I.

In: The American journal of medicine, Vol. 87, No. 5, 11.1989, p. 511-518.

Research output: Contribution to journalArticle

Robbins, RA, Linder, J, Stahl, MG, Thompson, AB, Haire, W, Kessinger, A, Armitage, JO, Arneson, M, Woods, G, Vaughan, WP & Rennard, SI 1989, 'Diffuse alveolar hemorrhage in autologous bone marrow transplant recipients', The American journal of medicine, vol. 87, no. 5, pp. 511-518. https://doi.org/10.1016/S0002-9343(89)80606-0
Robbins, Richard A. ; Linder, James ; Stahl, Marlin G. ; Thompson, Austin Bassett ; Haire, William ; Kessinger, Anne ; Armitage, James Olen ; Arneson, Mark ; Woods, Gail ; Vaughan, William P. ; Rennard, Stephen I. / Diffuse alveolar hemorrhage in autologous bone marrow transplant recipients. In: The American journal of medicine. 1989 ; Vol. 87, No. 5. pp. 511-518.
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