ALVEOLAR HEMORRHAGE - DIAGNOSTIC-CRITERIA AND RESULTS IN 194 IMMUNOCOMPROMISED HOSTS

To establish the diagnosis of alveolar hemorrhage (AH) in cells recove red by bronchoalveolar lavage (BAL), Golde and colleagues created a sc ore based on the hemosiderin content of alveolar macrophages stained w ith Prussian blue. We used an easier method, calculating the percentag e of siderophages among the total alveolar macrophages recovered by BA L. We have retrospectively studied this method in 240 BALs performed i n 194 immunocompromised patients. Prussian blue staining was performed on each BAL sample, and the Golde score was calculated for 47 samples chosen at random. The methods were compared for diagnosing AH. The pe rcentage of siderophages correlated well with the Golde score. AH was defined by at least 20% siderophages. This definition was validated by comparison with the method of Kahn and coworkers. AH was present in 8 7 (36%) of the samples and was significantly associated with four para meters: thrombocytopenia (< 50,000/mm(3)), other abnormal coagulation parameters, renal failure (creatinine greater than or equal to 2.5 mg/ dl), and a history of heavy smoking. The diagnosis of AH did not corre late with either the cause or the outcome of pneumonia. AH was seen mo re frequently in cardiac transplant patients (75%). In our experience, (1) a percentage of siderophages greater than or equal to 20% is suff icient and is an easier determinant of the diagnosis of AH than the Go lde score; and (2) AH is rarely the sole cause of lung injury and is u sually associated with other causes of pneumonia. AH may be considered more as a sign than as a distinct disease in this population.