DIFFUSE ALVEOLAR HEMORRHAGE IN ALLOGENEIC BONE-MARROW TRANSPLANTATION- A POSTMORTEM STUDY

To define better the syndrome of diffuse alveolar hemorrhage (DAH), we conducted a postmortem study in 77 patients who died of pulmonary com plications, distributed into three groups. Group A included 47 patient s with hematologic diseases treated with allogeneic bone marrow transp lant (BMT); Group B, 20 patients with hematologic diseases treated wit h conventional chemotherapy; and Group C, 10 patients without hematolo gic diseases. The diagnosis of DAH was established when there was bloo d in at least 30% of the lung tissue evaluated without evidence of inf ection or any other pathologic change that could account for its prese nce. The presence of an associated pulmonary complication was consider ed only when there was normal lung parenchyma between both blood and t he specific lesions. Diffuse alveolar hemorrhage was shown in 11 patie nts in Group A (23%) compared with 1 patient in Group B (5%) (p < 0.05 ). Of the 11 patients with DAH in Group A, 10 had some associated pulm onary complication: 7 presented with diffuse alveolar damage (DAD), 2 with associated bacterial pneumonia and 1 with invasive aspergillosis, 2 others had an associated cytomegalovirus (CMV) pneumonitis, and the remaining patients had an associated herpes pneumonia. There were no clinical differences between patients with and without DAH. Of 8 patie nts with confirmed DAH in Group A, who had been submitted to a broncho scopic examination within 1 wk of death, 4 had normal BAL fluid; by co ntrast, 7 of 13 patients without DAH had hemorrhagic BAL fluid. It is concluded that (1) DAH is a common contributing factor to death in pat ients treated with allogeneic BMT; (2) DAH usually occurs in associati on with other pulmonary complications; and (3) the validity of BAL in the diagnosis of DAH appears to be poor in this study.