Pulmonary hemorrhage
| Pulmonary hemorrhage | |
|---|---|
| File:Pulmonary haemorrhage - low mag.jpg
Micrograph showing a pulmonary haemorrhage. H&E stain.
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| Classification and external resources | |
| Specialty | Lua error in Module:Wikidata at line 446: attempt to index field 'wikibase' (a nil value). |
| ICD-10 | P26, R04.8 |
| ICD-9-CM | 770.3 |
| eMedicine | article/1002002 |
| Patient UK | Pulmonary hemorrhage |
Pulmonary hemorrhage (or "pulmonary haemorrhage") is an acute bleeding from the lung, especially in the upper respiratory tract and the trachea. When evident clinically, the condition is usually massive, associated with bleeding in other sites as well as more than one third of the lungs.[1] The onset of pulmonary hemorrhage is characterized by oozing of bloody fluid from the nose and endotracheal tube, as well as to a lesser extent in other places, accompanied by rapid worsening of patient respiration, cyanosis and, in severe cases, shock.[1] Treatment should be immediate and should include tracheal suction, oxygen, positive pressure ventilation, and correction of underlying abnormalities (e.g. disorders of coagulation). A blood transfusion may be necessary.[1]
Contents
Incidence
The outcome of treatment is dependent on causality. Pulmonary Hemorrhage is present in 7 to 10% of neonatal autopsies, but up to 80% of autopsies of very preterm infants.[1] The incidence is 1 in 1,000 live births.[1] Pulmonary hemorrhage has a high mortality rate of 30% to 40%.[1]
Causes
Infant prematurity is the factor most commonly associated with pulmonary hemorrhage. Other associated factors are those that predispose to perinatal asphyxia or bleeding disorders, including toxemia of pregnancy, maternal cocaine use, erythroblastosis fetalis, breech delivery, hypothermia, infection, Infant respiratory distress syndrome (IRDS), administration of exogenous surfactants (in some studies) and Extracorporeal membrane oxygenation (ECMO).[1]
Pathogenesis
Although the pathogenesis is uncertain, it is probable that the symptoms are a consequence of hemorrhagic pulmonary edema, as the hematocrit is lower than normal blood (usually 15-20% less) and the concentration of small proteins is higher than in plasma.[1] It is postulated that the infant suffers from asphyxia with resultant heart attack; this increases pulmonary microvascular pressure, resulting in pulmonary edema.[1] Contributing factors include factors that favor increased filtration of fluid from pulmonary capillaries (e.g., low concentration of plasma proteins, high alveolar surface tension, lung damage, hypervolemia).[1]
Diffuse alveolar hemorrhage
Diffuse alveolar hemorrhage is bleeding from many alveoli throughout the lungs. Common causes include autoimmune diseases and connective tissue diseases.[2]
