Haemosiderin-laden macrophages in the bronchoalveolar lavage fluid of patients with diffuse alveolar damage

Abstract

Quantification of haemosiderin-laden macrophages in bronchoalveolar lavage fluid (BALF) has been used to diagnose diffuse alveolar haemorrhage (DAH) but has not been assessed in patients with diffuse alveolar damage (DAD).The present study analysed BALF obtained from 21 patients with DAD diagnosed by surgical lung biopsy.The median age of 21 patients with DAD was 68 yrs (range 18-79 yrs); 14 (67%) were male and 12 (57%) were immunocompromised. The median proportion of haemosiderin-laden macrophages in BALF was 5% (range 0-90%), but was o20% in seven (33%) patients, fulfilling the commonly used BALF criterion for DAH. There was a trend toward a positive correlation between the percentage of haemosiderin-laden macrophages in BALF and parenchymal haemorrhage assessed semiquantitatively by histopathological analysis. Patients with o20% haemosiderinladen macrophages in BALF showed a significantly increased mortality rate (p50.047) compared to those with ,20%.In patients with an acute onset of diffuse lung infiltrates and respiratory distress, o20% haemosiderin-laden macrophages in BALF can occur with DAD, and is not necessarily diagnostic of DAH. The finding of o20% haemosiderin-laden macrophages in BALF is associated with a worse prognosis in patients with DAD.

IL-10R Blockade during Chronic Schistosomiasis Mansoni Results in the Loss of B Cells from the Liver and the Development of Severe Pulmonary Disease

“…Moreover, hepatic levels of IL-13, the major inducing factor for fibrosis in schistosomiasis, were also unchanged as a result of IL-10R blockade (Figure 3D). However, we found evidence of hepatic bleeding, apparent as red blood cells and plasma in extravascular spaces with a loss of cellular structure (Figure 3E), and marked deposition of hemosiderin (an indicator of bleeding [24], [25]) (Figure 3F), in mice that were treated with anti-IL-10R. Hemosiderin was localized to F4/80 + cells that exhibit macrophage-like morphology (Figure 3F).…”

Sequential adjuvant chemoradiotherapy-induced diffuse alveolar haemorrhage in a patient with breast cancer successfully treated with corticosteroid plus recombinant human soluble thrombomodulin

“…In fact, the histopathological findings in CS-refractory RILI with DAH have been reported to be mostly caused by DAD 13. DAD with DAH has a significantly poorer prognosis compared with DAD without DAH 14. Therefore, we considered that additional treatment was necessary for her sequential CRT-induced life-threating DAH.…”

HFE gene variants and iron-induced oxygen radical generation in idiopathic pulmonary fibrosis

“…Increased levels of iron have been found in the lower respiratory tract of subjects with pulmonary idiopathic siderosis, where iron is entirely bound to ferritin to prevent excessive oxidative stress [30]. Increased levels of haemosiderin iron are also found in pulmonary veno-occlusive disease, where Prussian blue stained alveolar macrophages and type II pneumocytes are seen in the absence of frank fibrosis [31], and in diffuse alveolar damage, concomitant with moderate to severe alveolar haemorrhage [32]. Finally, in some transfusion-dependent thalassaemia patients, systemic iron overload has been associated with functional and histopathological abnormalities, including bronchial iron deposition and fibrosis [33][34][35].…”