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Diffuse alveolar hemorrhage associated with thrombotic thrombocytopenic purpura after allogeneic bone marrow transplantation
Alveolar hemorrhage is an early complication after bone marrow transplantation (BMT) and often associated with inflammatory pulmonary processes. We present a case of diffuse alveolar hemorrhage associated with BMT associated thrombotic thrombocytopenic purpura (BMT-TTP). An 18-years-old man with acute myeloid leukaemia (FAB; M5) underwent ABO incompatible BMT from his HLA-identical sister. On the 37th day of BMT, BMT-TTP was diagnosed with the occurrence of red cell fragmentation and rise in serum lactic dehydrogenase (LDH) level with severe sudden decrease in hemoglobin and platelet levels. Cyclosporine A (CsA) was ceased and plasma infusion with plasma exchange was started. On the 42nd day of BMT, the diagnosis of diffuse alveolar hemorrhage was made by the clinical, bronchoscopic and bronchoalveolar lavage fluid findings. Alveolar hemorrhage among patients with BMT-TTP has been scarce reported. These two complications may be regarded as related, as small vessel injury is a central feature in both and they may share aetiological and pathogenetic factors.

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Authors: Sevgi Kalayoğlu Beşışık, Mustafa Yenerel, Reyhan Diz Küçükkaya, Yaşar Çalışkan, Deniz Sargın

Keywords: Alveoler, Hemoraji, Trombotik trombositopenik purpura, Kök hücre nakli.

  • Year: 2004
  • Number: 4
  • Referance No: 39260
  • Figure 1. Serum LDH, platelet, hemoglobin and creatinine levels of patient. With the increasing LDH levels, platelet and hemoglobin levels showed decrements and microangiopathic hemolytic anemia/TTP occurred. *On day +23, serum creatinine level increased from 1.2 mg/dL to 2.1 mg/dL with a blood CsA level of 500 ng/mL and CsA was ceased. **On day +37, acute GVHD grade II was diagnosed. ***On day +39, despite the regression of acute GVHD, BMT associated TTP was noted. Cyclosporine A was ceased again and plasmapheresis was started.
  • Figure 2a. Posteroanterior chest X ray film showing bilateral diffuse alveolar opacities.
  • Figure 2b. Thorax computed tomogram of the chest showing diffuse alveolar hemorrhage.

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