Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Letter to the Editor
  • Published:

Diffuse alveolar hemorrhage after unrelated cord blood transplantation

Bone Marrow Transplantation volume 45, pages 789–790 (2010)Cite this article

Diffuse alveolar hemorrhage (DAH) is a recognized pulmonary complication in the setting of hematopoietic STC (HSCT). DAH after HSCT is often fatal, but the exact etiology remains unclear. DAH after HSCT is reported in 1–5% of autologous graft recipients and in 3–7% of allogeneic graft recipients.1, 2, 3, 4 Umbilical cord blood transplantation (CBT) from unrelated donors has recently increased in popularity for adult patients with hematological diseases who have no other suitable donor. However, DAH in the setting of post CBT has not been discussed in detail.4 We describe herein, a case of a patient with DAH after CBT who was successfully treated with relatively low-dose steroid therapy using prednisolone at 1 mg/kg/day.

Diffuse alveolar hemorrhage is one of the early complications after HSCT, and is unrelated to low plt counts. Factors predictive of increased incidence of alveolar hemorrhage after HSCT include older age, use of myeloablative conditioning, infections (particularly respiratory infections) and presence of severe acute GVHD.1, 2, 3, 4, 5 The underlying undetected infections have been considered to have a role in the pathogenesis of DAH in some reports.1, 2, 3, 4, 6 One such report described an association between infections and hemorrhagic complications in an autopsy series.6

This is a preview of subscription content, access via your institution

Relevant articles

Open Access articles citing this article.

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1

References

  1. Yen KT, Lee AS, Krowka MJ, Burger CD . Pulmonary complications in bone marrow transplantation: a practical approach to diagnosis and treatment. Clin Chest Med 2004; 25: 189–201.

    Article  Google Scholar 

  2. Afessa B, Tefferi A, Litzow MR, Peters SG . Diffuse alveolar hemorrhage in hematopoietic stem cell transplant recipients. Am J Respir Crit Care Med 2002; 166: 641–645.

    Article  PubMed  Google Scholar 

  3. Lewis ID, Defor T, Weisdorf DJ . Increasing incidence of diffuse alveolar hemorrhage following allogeneic bone marrow transplantation: cryptic etiology and uncertain therapy. Bone Marrow Transplant 2000; 26: 539–543.

    Article  CAS  PubMed  Google Scholar 

  4. Majhail NS, Parks K, Defor TE, Weisdorf DJ . Diffuse alveolar hemorrhage and infection-associated alveolar hemorrhage following hematopoietic stem cell transplantation: related and high-risk clinical syndromes. Biol Blood Marrow Transplant 2006; 12: 1038–1046.

    Article  Google Scholar 

  5. Wojno KJ, Vogelsang GB, Beschorner WE, Santos GW . Pulmonary hemorrhage as a cause of death in allogeneic bone marrow recipients with severe acute graft-versus-host disease. Transplantation 1994; 57: 88–92.

    Article  CAS  PubMed  Google Scholar 

  6. Nuckols JD . Autopsy findings in umbilical cord blood transplant recipients. Am J Clin Pathol 1999; 112: 335–342.

    Article  CAS  Google Scholar 

  7. Metcalf JP, Rennard SI, Reed EC, Haire WD, Sisson JH, Walter T et al. Corticosteroids as adjunctive therapy for diffuse alveolar hemorrhage associated with bone marrow transplantation. University of Nebraska Medical Center Bone Marrow Transplant Group. Am J Med 1994; 96: 27–334.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Hematology and Stem Cell Transplantation, Shizuoka Cancer Center, Shizuoka, Japan

    M Uchiyama & T Ikeda

Authors
  1. M Uchiyama
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. T Ikeda
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M Uchiyama.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Uchiyama, M., Ikeda, T. Diffuse alveolar hemorrhage after unrelated cord blood transplantation. Bone Marrow Transplant 45, 789–790 (2010). https://doi.org/10.1038/bmt.2009.219

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/bmt.2009.219

This article is cited by

Search

Advanced search

Quick links