Factors Associated with Fatal Hemoptysis in Cancer Patients: Outcome
Candida spp may also play a causative role in pulmonary hemorrhage as demonstrated by two patients with hemoptysis and a Candida pneumonia. One of these patients had a C tropicalis pneumonia and developed fatal hemoptysis, whereas the patient with a C albicans pneumonia experienced only selflimited hemoptysis. The increased virulence of C tropicalis has been previously described in granulocytopenic patients, the basis for which may be elaboration of extracellular proteases. life without allergy
Hemoptysis not associated with a pneumonitis (IAH) occurred frequently (9/24) in our patients with a hematologic malignancy and, in contrast to those patients with a fungal pneumonia, was fatal in only two of nine patients. The pathogenesis for pulmonary hemorrhage in the absence of infection may be due to several factors. Several investigators have suggested that thrombocytopenia is a major cause of hemoptysis in these patients. Alternatively, Smith and Katzenstein have recently suggested that diffuse alveolar damage must be present in addition to thrombocytopenia to cause intra-alveolar hemorrhage, because many patients experience pulmonary bleeding with normal platelet counts, and platelet transfusions alone do not prevent pulmonary hemorrhage. The pathologic features of diffuse alveolar damage are nonspecific and occur following a variety of insults that produce injury to alveolar epithelial and endothelial cells. Causative factors of diffuse alveolar damage include ingestion of cyclophosphamide and cytosine arabinoside, which was administered to 11 of our 16 patients with I AH, as well as radiation, sepsis, and viral infestations. Radiation therapy was not administered to any of our patients with a hematologic malignancy and I AH, but bacteremia, present in seven patients, may have played a role in the development of diffuse alveolar damage. Many of our patients required mechanical ventilation, but whether this modality contributes to diffuse alveolar damage could not be determined from this study.