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J Pediatr Intensive Care 2019; 08(03): 181-186
DOI: 10.1055/s-0039-1679904
Case Report
Georg Thieme Verlag KG Stuttgart · New York

Extracorporeal Membrane Oxygenation for Diffuse Alveolar Hemorrhage Caused by Idiopathic Pulmonary Hemosiderosis: A Case Report and a Review of the Literature

Shotaro Matsumoto 
1   Division of Critical Care Medicine, National Center for Child Health and Development, Setagaya, Tokyo, Japan
,
Satoshi Nakagawa
1   Division of Critical Care Medicine, National Center for Child Health and Development, Setagaya, Tokyo, Japan
› Author Affiliations
Further Information

Publication History

11 October 2018

13 January 2019

Publication Date:
25 February 2019 (online)

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Abstract

Diffuse alveolar hemorrhage (DAH) is a life-threatening condition presenting with hemoptysis, anemia, and diffuse radiographic pulmonary infiltrates; it causes acute respiratory failure. Idiopathic pulmonary hemosiderosis (IPH) is a rare cause of DAH occurring predominantly in children. Bleeding is often considered to be a contraindication for extracorporeal membrane oxygenation (ECMO) due to systemic anticoagulation. We present an 8-year-old girl with DAH caused by IPH. Unfractionated heparin was administered to maintain an activated clotting time of 150 to 180 seconds. The DAH resolved with immunosuppressive therapy, and the patient survived to decannulation. ECMO may be applied as a rescue therapy for DAH even with systemic anticoagulation.

Keywords

extracorporeal membrane oxygenation - diffuse alveolar hemorrhage - idiopathic pulmonary hemosiderosis
 

  • References

  • 1 Lara AR, Schwarz MI. Diffuse alveolar hemorrhage. Chest 2010; 137 (05) 1164-1171
    CrossrefPubMedSearch in Google Scholar
  • 2 Susarla SC, Fan LL. Diffuse alveolar hemorrhage syndromes in children. Curr Opin Pediatr 2007; 19 (03) 314-320
    CrossrefPubMedSearch in Google Scholar
  • 3 Brodie D, Bacchetta M. Extracorporeal membrane oxygenation for ARDS in adults. N Engl J Med 2011; 365 (20) 1905-1914
    CrossrefPubMedSearch in Google Scholar
  • 4 Abrams D, Agerstrand CL, Biscotti M, Burkart KM, Bacchetta M, Brodie D. Extracorporeal membrane oxygenation in the management of diffuse alveolar hemorrhage. ASAIO J 2015; 61 (02) 216-218
    CrossrefPubMedSearch in Google Scholar
  • 5 Muellenbach RM, Kredel M, Kunze E. , et al. Prolonged heparin-free extracorporeal membrane oxygenation in multiple injured acute respiratory distress syndrome patients with traumatic brain injury. J Trauma Acute Care Surg 2012; 72 (05) 1444-1447
    CrossrefPubMedSearch in Google Scholar
  • 6 Sun LC, Tseng YR, Huang SC. , et al. Extracorporeal membrane oxygenation to rescue profound pulmonary hemorrhage due to idiopathic pulmonary hemosiderosis in a child. Pediatr Pulmonol 2006; 41 (09) 900-903
    CrossrefPubMedSearch in Google Scholar
  • 7 Gutierrez S, Shaw S, Huseni S. , et al. Extracorporeal life support for a 5-week-old infant with idiopathic pulmonary hemosiderosis. Eur J Pediatr 2014; 173 (12) 1573-1576
    CrossrefPubMedSearch in Google Scholar
  • 8 Park MS. Diffuse alveolar hemorrhage. Tuberc Respir Dis (Seoul) 2013; 74 (04) 151-162
    CrossrefPubMedSearch in Google Scholar
  • 9 Alanio A, Hauser PM, Lagrou K. , et al; 5th European Conference on Infections in Leukemia (ECIL-5), a joint venture of The European Group for Blood and Marrow Transplantation (EBMT), The European Organization for Research and Treatment of Cancer (EORTC), the Immunocompromised Host Society (ICHS) and The European LeukemiaNet (ELN). ECIL guidelines for the diagnosis of Pneumocystis jirovecii pneumonia in patients with haematological malignancies and stem cell transplant recipients. J Antimicrob Chemother 2016; 71 (09) 2386-2396
    CrossrefPubMedSearch in Google Scholar
  • 10 Taytard J, Nathan N, de Blic J. , et al; French RespiRare® group. New insights into pediatric idiopathic pulmonary hemosiderosis: the French RespiRare(®) cohort. Orphanet J Rare Dis 2013; 8: 161
    CrossrefPubMedSearch in Google Scholar
  • 11 Siden HB, Sanders GM, Moler FW. A report of four cases of acute, severe pulmonary hemorrhage in infancy and support with extracorporeal membrane oxygenation. Pediatr Pulmonol 1994; 18 (05) 337-341
    CrossrefPubMedSearch in Google Scholar
  • 12 Kolovos NS, Schuerer DJ, Moler FW. , et al. Extracorporal life support for pulmonary hemorrhage in children: a case series. Crit Care Med 2002; 30 (03) 577-580
    CrossrefPubMedSearch in Google Scholar
  • 13 Agarwal HS, Taylor MB, Grzeszczak MJ. , et al. Extra corporeal membrane oxygenation and plasmapheresis for pulmonary hemorrhage in microscopic polyangiitis. Pediatr Nephrol 2005; 20 (04) 526-528
    CrossrefPubMedSearch in Google Scholar
  • 14 Di Maria MV, Hollister R, Kaufman J. Case report: severe microscopic polyangiitis successfully treated with extracorporeal membrane oxygenation and immunosuppression in a pediatric patient. Curr Opin Pediatr 2008; 20 (06) 740-742
    CrossrefPubMedSearch in Google Scholar
  • 15 Hung JT, Yang YH, Hsiao CH. , et al. Leukocytoclastic vasculitis with severe cardiac involvement in an infant: a case report. Clin Rheumatol 2008; 27 (07) 945-947
    CrossrefPubMedSearch in Google Scholar
  • 16 Morris SH, Haight AE, Kamat P, Fortenberry JD. Successful use of extracorporeal life support in a hematopoietic stem cell transplant patient with diffuse alveolar hemorrhage. Pediatr Crit Care Med 2010; 11 (01) e4-e7
    CrossrefPubMedSearch in Google Scholar
  • 17 Joseph M, Charles AG. Early extracorporeal life support as rescue for Wegener granulomatosis with diffuse alveolar hemorrhage and acute respiratory distress syndrome: a case report and literature review. Pediatr Emerg Care 2011; 27 (12) 1163-1166
    CrossrefPubMedSearch in Google Scholar
  • 18 Nathan M, Kalyanaraman M, Blank J, Hardin JT, Starr JP. The use of extracorporeal membrane oxygenation, high-frequency oscillatory ventilation, and surfactant for the management of intraoperative acute pulmonary hemorrhage in tetralogy of Fallot. J Cardiothorac Vasc Anesth 2011; 25 (02) 313-315
    CrossrefPubMedSearch in Google Scholar
  • 19 Cisco MJ, Asija R, Dubin AM, Perry SB, Hanley FL, Roth SJ. Survival after extreme left atrial hypertension and pulmonary hemorrhage in an infant supported with extracorporeal membrane oxygenation for refractory atrial flutter. Pediatr Crit Care Med 2011; 12 (03) e149-e152
    CrossrefPubMedSearch in Google Scholar
  • 20 Son SK, Oh SH, Kim KM. , et al. Successful liver transplantation following veno-arterial extracorporeal membrane oxygenation in a child with fulminant Wilson disease and severe pulmonary hemorrhage: a case report. Pediatr Transplant 2012; 16 (07) E281-E285
    CrossrefPubMedSearch in Google Scholar
  • 21 Dalabih A, Pietsch J, Jabs K, Hardison D, Bridges BC. Extracorporeal membrane oxygenation as a platform for recovery: a case report of a child with pulmonary hemorrhage, refractory hypoxemic respiratory failure, and new onset goodpasture syndrome. J Extra Corpor Technol 2012; 44 (02) 75-77
    PubMedSearch in Google Scholar
  • 22 Keller R, Torres S, Iölster T. , et al. [Extracorporeal membrane oxygenation and plasmapheresis in the treatment of severe pulmonary hemorrhage secondary to nodose polyarteritis]. Arch Argent Pediatr 2012; 110 (04) e80-e85
    CrossrefPubMedSearch in Google Scholar
  • 23 Hong X, Feng Z, Zhou G, Xu X. Extracorporeal membrane oxygenation as a support for TGA/IVS with low cardiac output syndrome and pulmonary hemorrhage. Rev Bras Cir Cardiovasc 2013; 28 (02) 292-295
    CrossrefPubMedSearch in Google Scholar
  • 24 Bembea MM, Annich G, Rycus P, Oldenburg G, Berkowitz I, Pronovost P. Variability in anticoagulation management of patients on extracorporeal membrane oxygenation: an international survey. Pediatr Crit Care Med 2013; 14 (02) e77-e84
    CrossrefPubMedSearch in Google Scholar
  • 25 Dalton HJ, Reeder R, Garcia-Filion P. , et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network. Factors associated with bleeding and thrombosis in children receiving extracorporeal membrane oxygenation. Am J Respir Crit Care Med 2017; 196 (06) 762-771
    CrossrefPubMedSearch in Google Scholar
  • 26 Kimura D, Shah S, Briceno-Medina M. , et al. Management of massive diffuse alveolar hemorrhage in a child with systemic lupus erythematosus. J Intensive Care 2015; 3: 10
    CrossrefPubMedSearch in Google Scholar
  • 27 Mongero LB, Brodie D, Cunningham J. , et al. Extracorporeal membrane oxygenation for diffuse alveolar hemorrhage and severe hypoxemic respiratory failure from silicone embolism. Perfusion 2010; 25 (04) 249-252 , discussion 253–254
    CrossrefPubMedSearch in Google Scholar
  • 28 Newall F, Johnston L, Ignjatovic V, Monagle P. Unfractionated heparin therapy in infants and children. Pediatrics 2009; 123 (03) e510-e518
    CrossrefPubMedSearch in Google Scholar
  • 29 Petrikkos G, Skiada A, Lortholary O, Roilides E, Walsh TJ, Kontoyiannis DP. Epidemiology and clinical manifestations of mucormycosis. Clin Infect Dis 2012; 54 (Suppl. 01) S23-S34
    CrossrefPubMedSearch in Google Scholar
  • 30 Rammaert B, Lanternier F, Zahar JR. , et al. Healthcare-associated mucormycosis. Clin Infect Dis 2012; 54 (Suppl. 01) S44-S54
    CrossrefPubMedSearch in Google Scholar