Pulmonary hemorrhage (PH), defined as extravasations of blood into airways and/or lung parenchyma
Pulmonary haemorrhage is an acute bleeding from the lung, from the upper respiratory tract, the trachea, and the alveoli. The onset of pulmonary hemorrhage is characterized by productive cough with blood (hemoptysis) and worsening of oxygenation leading to cyanosis.
- Infant prematurity is the factor most commonly associated with pulmonary hemorrhage.
- Toxemia of pregnancy
- Maternal cocaine use
- Erythroblastosis Fetalis
- Breech delivery
- Infant respiratory distress syndrome (IRDS)
- Extracorporeal membrane oxygenation (ECMO)
- Surfactant therapy
Risk Factors of Pulmonary Hemorrhage
The common risk factors that increase the chance of pulmonary hemorrhage include:
- Males are affected more often
- Intrauterine growth restriction or IUGR
- Patent Ductus Arteriosus
- Diffused alveolar bleeding either alone or together with eye lesions, rashes, hepatosplenomegaly
- Coughing associated with blood discharge, dyspnea, and fever.
- Sub-acute or acute condition results in a complete respiratory failure which may require mechanical ventilation otherwise can be fatal.
- Hemoptysis is a common symptom but not observed in one-third of the patients because of increase in alveolar volume.
- Continuous bleeding with decreased hematocrit (HCT) level resulting in anemia
- Recurrent episodes of this disease lead to diffusion of alveolar infiltrate, collagen deposition in insignificant airways, organizing pneumonia, and fibrosis
Diagnosis of Pulmonary Hemorrhage
The common method of identifying the disease symptoms as well as the progression includes the following:
- Common Laboratory Investigations: These include:
- Platelets count
- Broncho-alveolar lavage
- Complete Blood Count or CBC
- Coagulation studies (Prothrombin time n-11-13.5 sec), thrombin time n- 14-19 sec, activated partial thromboplastin n- 30-40 sec)
- Pulmonary function tests including elevated DLCO (diffusion capacity of the lungs for Carbonmonoxide), usually restrictive is greater than an obstructive pattern with the low exhalation of Nitric Oxide.
- Radiographic Imaging: The radiographic diagnosis includes –
- Chest X-ray for detecting patchy alveolar opacification
- CT chest for detecting spreading of the disease in normal areas
- HRCT (high resolution CT) pattern varies with the beginning of the hemorrhage.
- Serologic tests are performed to find out the exact underlying disorders.
- Echocardiography may also require if there is mitral stenosis.
- Lung or renal biopsy is often done when a cause is undetectable or if the progression of the disease is very fast. Specimens usually show blood along with numerous siderophages and erythrocytes; lavage fluid characteristically remains hemorrhagic or becomes highly hemorrhagic just after consecutive sampling.
- To decrease and stop the bleeding in the lungs.
- To identify the underlying cause.
- To improve gaseous exchange.
- To improve distress
- Through or by suctioning the airway initially until the bleeding subsides.
- By increasing oxygen support.
- Mechanical ventilation should be given in massive pulmonary hemorrhage.
- Packed Red Blood Cells to correct blood volume and hematocrit levels.
- Through administering blood, this will correct hypovolemia, hypoxia and also correct low cardiac output.
- Identifying and treating the cause
- Rescue surfactant by using a single dose of surfactant after the infant has been stabilized on the ventilator.
- Hemocoagulase: Is a new treatment method discovered from a brazilian snake’s venom. It has a thromboplastin-like effect that coverts prothrombin to thrombin and fibrinogen to fibrin. Its measured in KU(Klobusitzky Units) and dose os 0.5KU every 4-6 hours until hemorrhage is stopped.
- Activated Recombinant Factor VIIa (rFVIIa): This drug works by activating the extrinsic pathway and binds to tissue factor which will eventually bind and seal sites with vascular injury. For effectiveness o this drug, platelets can be administered too. The dosage is 50mg/kg twice daily for 2 – 3 days.
- Low-molecular-weight Heparin: This drug is found to provide better patient outcome for neonatal pulmonary hemorrhage as it does improve the pulmonary function and coagulation function and reduce the incidence of getting complications.
- Diuretics and steroids can also be helpful.