Chapter

Pulmonary haemorrhagic disorders

D.J. Hendrick and G.P. Spickett

in Oxford Textbook of Medicine

Fifth edition

Published on behalf of Oxford University Press

ISBN: 9780199204854
Published online May 2012 | e-ISBN: 9780199570973 | DOI: http://dx.doi.org/10.1093/med/9780199204854.003.181401

Series: Oxford Textbooks

Pulmonary haemorrhagic disorders

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There are many causes of bleeding within the lung and haemoptysis, but the term ‘pulmonary haemorrhagic disorder’ applies only to diffuse bleeding from pulmonary alveolar capillaries. The condition is characterized by haemoptysis (not invariable), breathlessness, diffuse air space shadowing on the chest radiograph, anaemia (normochromic normocytic if acute, iron deficient with chronicity), and elevated carbon monoxide gas transfer (TLco).

Goodpasture’s disease—diffuse pulmonary haemorrhage and glomerulonephritis with linear deposition of antibodies along the glomerular basement membrane (anti-GBM antibodies). Renal failure is a much commoner threat to survival than lung haemorrhage, but in some cases (almost invariably smokers) the latter can be life threatening. Treatment is supportive (artificial ventilation occasionally necessary) and with steroids, other immunosuppressants (cyclophosphamide) and plasmapheresis.

Idiopathic pulmonary haemosiderosis—a rare disorder of unknown cause with recurrent alveolar bleeding. Chest imaging shows the nonspecific appearances of intra-alveolar blood, which usually clears spontaneously over 1 to 3 weeks, but with chronicity diffuse pulmonary fibrosis with honeycombing may supervene. Treatment is supportive.

Other causes—pulmonary haemorrhage may occur with or complicate a wide variety of disorders with vasculitic, immunological, infective, vascular, haemostatic, toxic, or unknown origins.

Chapter.  2049 words.  Illustrated.

Subjects: Respiratory Medicine and Pulmonology

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