title: Diffuse alveolar hemorrhage following allogeneic bone marrow transplantation in children.
abstract: BACKGROUND
  Diffuse alveolar hemorrhage (DAH) is a frequent life-threatening complication of bone marrow transplantation (BMT) in adults. This noninfectious pulmonary disorder is rarely reported following BMT in neonates and children.
  
  
  OBJECTIVE
  To review the clinical features and course of children who underwent allogeneic BMT and developed DAH in the posttransplant period.
  
  
  METHODS
  A retrospective 6-year chart review.
  
  
  METHODS
  Pediatric ICU in a university hospital.
  
  
  METHODS
  At total of 138 children who had undergone allogeneic BMT for nonmalignant (n = 66) or malignant (n = 72) diseases.
  
  
  RESULTS
  Six of 138 children (4.3%) aged 2 months to 10 years (male/female ratio, 1:1) developed DAH. Each had a fulminant course with rapidly developing severe respiratory failure, mandating mechanical ventilation within 24 h following symptom onset. They were all treated with methylprednisolone, 6 mg/kg/d for 3 days. Only one child survived, and there have been no sequelae at 2 years post-BMT. Four children died of respiratory causes, and one died of multiorgan failure.
  
  
  CONCLUSIONS
  DAH is a potentially fatal respiratory complication that should be included early in the differential diagnosis of acute respiratory failure in children following allogenic BMT for both malignant and nonmalignant diseases. Therapy with high doses of steroids apparently do not affect the course of the disease.
authors.affiliation: General Intensive Care Unit, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.
authors.forename: Ron
authors.initials: R
authors.lastname: Ben-Abraham
authors.forename: Gideon
authors.initials: G
authors.lastname: Paret
authors.forename: Rinat
authors.initials: R
authors.lastname: Cohen
authors.forename: Oded
authors.initials: O
authors.lastname: Szold
authors.forename: Gabriel
authors.initials: G
authors.lastname: Cividalli
authors.forename: Amos
authors.initials: A
authors.lastname: Toren
authors.forename: Arnon
authors.initials: A
authors.lastname: Nagler
mesh_terms: D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D016026:Bone Marrow Transplantation; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008171:Lung Diseases / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use; D019106:Postoperative Hemorrhage / Q000401:mortality* / Q000628:therapy; D012121:Respiration, Artificial; D012189:Retrospective Studies
chemical_list: D000893:Anti-Inflammatory Agents; D008775:Methylprednisolone