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Monday, 2 December 2013

Hemorrhaging: Pulmonary hemorrhage (P-Hem) - The Causes and Risk Factors

Hemorrhaging is also known as bleeding or abnormal bleeding as a result of blood loss due to internal.external leaking from blood vessels or through the skin.
Pulmonary hemorrhage (P-Hem)
Pulmonary hemorrhage is defined  as a acute condition of lung bleeding from the from the upper respiratory tract or the endotracheal tube of the lung with the mortality of 30 to 40%. 
Causes and Rick factors
A. Causes  
1. Pulmonary Embolism
In the study to determine the characteristics of the history, physical examination, chest radiograph, electrocardiogram, and the ventilation/perfusion lung scan probability in elderly patients with pulmonary embolism who present with the syndrome of pulmonary infarction or hemorrhage, found that although a few clinical features of the pulmonary hemorrhage/infarction syndrome of pulmonary embolism in elderly patients differ from patients less than 40 years of age, in general, the clinical characteristics are comparable to younger patients(1).

2. Bacteria infection
Enterovirus 71 (EV71) infection with pulmonary edema or pulmonary hemorrhage as a fulminant and often fatal illness(2). Others report a case of a 63-year-old woman treated by intensive chemotherapy for acute myeloid leukemia (AML) who presented while severely neutropenic and thrombocytopenic a Sm pulmonary infection with hemoptysis leading to death in 48 h, according to the study of Lethal pulmonary hemorrhage caused by a fulminant Stenotrophomonas maltophilia respiratory infection in an acute myeloid leukemia patient(3).

3. Lung cancer
In the study to investigate  the risk factors associated with fatal pulmonary hemorrhage (PH) in patients with locally advanced non-small cell lung cancer (NSCLC), treated with chemoradiotherapy, showed that f the 583 patients, 2.1% suffered a fatal PH. The numbers of patients with minimum, minor, and major cavitations were 13, 11, and 14, respectively. Among the 38 patients with tumor cavitation, all 3 patients who developed fatal PH had major cavitations. On multivariate analysis, the presence of baseline major cavitation (odds ratio, 17.878), and a squamous cell histology (odds ratio, 5.491) proved to be independent significant risk factors for fatal PH. Interestingly, all patients with fatal PH and baseline major cavitation were found to have tumors with squamous cell histology, and the occurrence of fatal PH in patients having both risk factors was 33.3%(4).

4. Pneumonia 
In the review of the epidemiological, clinical and diagnosis findings of pneumonia and pulmonary hemorrhage observed in patients with leptospirosis in the period January 2007 to October 2009. A 64% (20/31) of patients diagnosed with leptospirosis presented pneumonia. Fifteen of them (75%) had severe pneumonia, of which seven (35%) were pulmonary hemorrhage. In ten patients (32%) reason for consultation and clinical early stage was a secretory gastroenteritis with fever and abdominal pain. Jaundice was only expressed in eleven patients (35%)(5).

5. Etc.

B. Risk factors
1. Extreme Exercise
There is a report of Exercise-induced pulmonary hemorrhage (EIPH) occurs in horses that race at high speeds(6)

2. Hereditary hemorrhagic telangiectasia and others
Hereditary hemorrhagic telangiectasia (Osler-Weber- Rendu disease) is inherited as an autosomal dominant trait with an incidence as high as 1:2300, according to the study of Hereditary hemorrhagic telangiectasia with pulmonary arteriovenous malformations. Prematurity is the factor most commonly associated with P-Hem; other associated factors are those that predispose to perinatal asphyxia or bleeding disorders, including toxemia of pregnancy, maternal cocaine use, erythroblastosis fetalis, breech delivery, hypothermia, infection, Respiratory Distress Syndrome, administration of exogenous surfactant (in some studies) and ECMO(7).

3. Etc.
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Sources
(1) http://www.ncbi.nlm.nih.gov/pubmed/11416457
(2) http://www.ncbi.nlm.nih.gov/pubmed/19099810
(3) http://www.ncbi.nlm.nih.gov/pubmed/15360016 
(4) http://www.ncbi.nlm.nih.gov/pubmed/22260460
(5) http://www.ncbi.nlm.nih.gov/pubmed/21550928
(6) http://www.ker.com/library/proceedings/04/EIPH_p95.pdf 
(7) http://www.ucsfbenioffchildrens.org/pdf/manuals/29_PulmHemorrhage.pdf