DiFFÜZ ALVEOLAR HEMORAJi SENDROMLARI

Öz

Diffüz alveoler hemoraji (DAH) sıklıkla akut solunum yetmezliğine yol açan klinikopatolojik bir sendromdur. DAH, genellikle bir grup immün kökenli heterojen hastalığa bağlı olarak gelişir ve alveoler septal hasardan masif hemorajiye kadar uzanan bir spektrumda seyreder. DAH tanısı klasik triadın varlığını içerir: Anemi, hemoptizi ve akciğer grafide yeni ortaya çıkan bilateral alveoler infiltratlar. Semptomlar, hemoptizi hariç siliktir. Ancak hemoptizi, olguların üçte birinde izlenmez. Radyolojik görüntüleme ve sistem tutulumları nonspesifiktir. Bronkoa-Iveoler lavaj (BAL) genellikle tanıyı doğrulamak için gereklidir: BAL örneğinde çok sayıda eritrositler ve sideofajların varlığının gösterilmesi ile tanı kesinleşir. Tedaviye başlamak için DAH’ye yol açan altta yatan patolojiye tanı koyulmalıdır. Tedavide hem alveolde meydana gelen otoimmün hasar hem de altta yatan durum hedeflenir. DAH tedavisinde kortikosteroi-dler ve immünsüpresif ajanlar uygulanır. Bu derlemede DAH’li olgularda DAH’ye yaklaşım, tanı, altta yatan sistemik hastalıklar ve tedavileri tartışıldı. Anahtar Kelimeler: Hemoraji, bronkoalveoler lavaj, tanı, hemoptizi

Anahtar Kelimeler

• Hemoraji
• bronkoalveoler lavaj
• tanı
• hemoptizi

SYNDROMES OF DIFFUSE ALVEOLAR HEMORRHAGE

Öz

Diffuse alveolar hemorrhage (DAH) is often a clinicopathologic syndrome causing acute respiratory failure. DAH, caused by generally a group of heterogenous disorders that origin from immüne pathologies, is characterized by the presence of widespread massive hemorrhage from damaged alveolar septa. The diagnosis of DAH involves the presence of classical triad: Anemia, hemoptysis and new bilateral alveoler infiltrates on chest radiograph. The symptoms are silent, except hemoptysis. But, hemoptysis is absent in up to one-third of the patients. Radiographic imaging and the involvement of system are nonspesific. Bronchoalveolar lavage (BAL) is generally required to confirm the diagnosis; blood in the lavage specimens (with numerous erythrocytes and siderophages) establishes the diagnosis. The underlying cause that are responsible for DAH must be diagnosed in order to initiate treatment. Both the autoimmune destruction of the alveol and the underlying conditions are targeted in the treatment. Corticosteroids and immunosuppressive agents are administered in DAH treatment. In this review, the approach to DAH, diagnosis, the underlying systemic diseases and treatment in patients with DAH are discussed.

Anahtar Kelimeler

• Hemorrhage
• bronchoalveolar lavage
• diagnosis
• hemoptysis

Kaynakça

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