Pulmonary bleeding

Winkler K et al. (1990) Effect of intraarterial versus intravenous cisplatin in addition to systemic doxorubicin, high-dose methotrexate, and ifosfamide on histologic tumor response in osteosarcoma (study COSS-86). Cancer 66 1703-1710 Witt C et al. (2000) Value of bronchial artery embolisation with platinum coils in tumorous pulmonary bleeding. Eur J Cancer 36 1949-1954... 

In pancytopenia, pulmonary bleeding occurs spontaneously, after interventions (e.g. BAL), or during haema-tological reconstitution after fungal pneumonia (Heus-SEL et al. 1997). 

Pulmonary bleeding might be a focal or diffuse pattern, and the phenomenon of sedimentation within the secondary lobules can sometimes be depicted (Fig. 27.17). 

Fig. 27.17. The bilateral ground-glass opacification has an anterior-posterior gradient over the whole-lung and within certain secondary lobules. This gravity dependence sedimentation phenomenon may occur temporarily and localised, e.g. after BAL or in diffuse pulmonary bleeding...

Additional supportive treatment may also be required for example, in patients with alveolar hemorrhage, preventing fluid overload may prevent further pulmonary bleeding, ventilation in the prone position may improve oxygenation, and treatment with activated factor Vila may diminish bleeding from the capillaritis (56). 

Deficiency of Factor VII is relatively rare and inherited as an autosomal recessive disorder. Deficiency of Factor VII has been reported to be associated with bond abnormal bleeding and thrombotic tendencies. Deep vein thrombosis and pulmonary emboli have been reported in affected individuals. There is a very high frequency of Factor VII deficiency in people with the Dubin-Johnson syndrome, which is a congenital disorder of Hver function. 

Therapeutically t-PA and urokinase are the most important drugs for fibrinolytic therapy (myocardial infarction, stroke, massive pulmonary embolism). This treatment is associated with an enhanced risk of bleeding complications. 

Plasma digoxin levels may decrease when the drug is administered with bleomycin. When bleomycin is used witii cisplatin, there is an increased risk of bleomycin toxicity Pulmonary toxicity may occur when bleomycin is administered with other antineoplastic drugs. Plicamycin, mitomycin, mitoxantrone, and dactino-mycin have an additive bone marrow depressant effect when administered with other antineoplastic drugs. In addition, mitomycin, mitoxantrone, and dactinomycin decrease antibody response to live virus vaccines. Dactinomycin potentiates or reactivates skin or gastrointestinal reactions of radiation therapy There is an increased risk of bleeding when plicamycin is administered witii aspirin, warfarin, heparin, and the NSAIDs. 

Contraindicated if patient has a bleeding diathesis, has hydrostatic pulmonary edema, or is anuric. Cautious use if patient is thrombocytopenic, has liver disease, or has a history of corn allergy... 

By far the most widely measured marker of hemostatic activation is D-dimer, which is a product formed by the action of plasmin on cross-linked fibrin (95). D-dimer levels in plasma are generally elevated in DIC. The consumption of platelets and coagulation proteins as a result of thrombin generation leads to the deposition of fibrin thrombi at multiple organ sites. This triggers fibrinolysis with an increase in the formation of fibrin degradation products, which can cause bleeding at multiple sites. Because DIC can have a variety of causes and may coexist with systemic fibrinolysis, such as in pulmonary embolism or deep vein thrombosis, the d-Dimer test is not specific for DIC (95). 

Tamoxifen is usually well tolerated. Symptoms of estrogen withdrawal (hot flashes and vaginal bleeding) may occur but decrease in frequency and intensity over time. Tamoxifen increases the risks of stroke, pulmonary embolism, deep vein thrombosis, and endometrial cancer, particularly in women age 50 years or older. 

Recent major bleeding (eg, intracranial, Gl, intraocular, pulmonary)... 

Animal studies also indicate that the respiratory system is a major target of toxicity following inhalation exposure to chlorine dioxide. Dalhamn (1957) reported the results of several inhalation studies in laboratory animals. In one study, a single 2-hour inhalation exposure of four rats to a chlorine dioxide concentration of 260 ppm (728 mg/m ) resulted in pulmonary edema and nasal bleeding. Respiratory distress was reported in three other rats subjected to 3 weekly 3-minute exposures to decreasing concentrations of airborne chlorine dioxide from 3,400 to 800 ppm (from 9,520 to 2,240 mg/m ) bronchopneumonia was observed in two of these rats. In a third rat study, repeated exposure to approximately 10 ppm (28 mg/m ) of chlorine dioxide (4 hours/day for 9 days in a 13-day period) resulted in rhinonhea, altered respiration, and respiratory infection. No indications of adverse effects were seen in rats exposed to approximately 0.1 ppm (0.28 mg/m ) of chlorine dioxide 5 hours /day for 10 weeks. 

Although an effective device, widespread utilization is limited by the need for trans-septal can-nulation. Severe peripheral vascular disease is a contraindication for TandemHeart, an often present co-morbid condition. Optimal pump performance is dependent on adequate filling pressures. Any condition that leads to a decrease in left atrial filling will affect pump flow. Possible causes are as follows right sided circulatory failure pulmonary hypertension, bleeding, hypovolemia, tamponade, and arrhythmias. 

The principal adverse reaction to warfarin is hemorrhage. Prolonged therapy with the coumarin-type anticoagulants is relatively free of untoward effects. Bleeding may be observable (e.g., skin, mucous membranes) or occult (e.g., gastrointestinal, renal, cerebral, hepatic, uterine, or pulmonary). Rarer untoward effects include diarrhea, small intestine necrosis, urticaria, alopecia, skin necrosis, purple toes, and dermatitis. 

Contraindications Dehydration, intracranial bleeding, severe pulmonary edema and congestion severe renal disease (anuria), increasing oliguria and azotemia... 

IV administration may result in a rare, severe hypersensitivity reaction marked by a feeling of warmth, pruritus, urticaria, weakness, diaphoresis, nausea, restlessness, tightness in throat, angioedema, cyanosis, pulmonary edema, G1 tract bleeding, and cardiovascular collapse. 

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