Abstract
Three previously healthy infants, 4-13 weeks old, presented with blood in the upper airway secondary to an acute pulmonary hemorrhage. Respiratory insufficiency developed, requiring an FiO2 of 1.0 in all patients, and ventilatory assistance in 2 of 3. Thorough investigation revealed no definite etiology of the hemorrhage, although one infant grew CMV from a nasopharyngeal aspirate. Hemosiderin laden macrophages (HLM) in tracheobronchial secretions were not present initially but appeared after 50 hours in one patient, and after 5 days in another. All initial episodes resolved rapidly following institution of corticosteroids. Steroids were withdrawn from one infant, who died 2 weeks later at home. Autopsy revealed an acute intraalveolar and interstitial hemorrhage without HLM. The other two patients received alternate day prednisone for 6 months and have remained well. Because no information was available regarding the time course of hemosiderin formation in the human lung, we investigated pulmonary alveolar macrophages (PAM) lavaged from normal volunteers and maintained in vitro. PAM exposed to heat treated (65°C for 4 hours) homologous RBC for 3 hours stained faintly for hemosiderin after 48 hours; the degree of staining continued to increase until 144 hours after RBC exposure. No HLM were observed in control cultures. The absence of HLM in airway secretions of children who have blood in their upper airway does not exclude the lower respiratory tract as the source of the bleeding. The appearance of HLM suggests the presence of blood in the lungs for more than 48 hours.
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Sherman, J., Winnie, G., Boat, T. et al. 1724 PULMONARY HEMORRHAGE IN PREVIOUSLY WELL INFANTS: TIME COURSE OF HEMOSIDERIN PRODUCTION. Pediatr Res 15 (Suppl 4), 731 (1981). https://doi.org/10.1203/00006450-198104001-01743
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DOI: https://doi.org/10.1203/00006450-198104001-01743