Hemorrhaging is also known as bleeding or abnormal bleeding as a
result of blood loss due to internal.external leaking from blood
vessels or through the skin.
Pulmonary hemorrhage (P-Hem)
Pulmonary hemorrhage is defined as a acute condition of lung bleeding from the from the upper respiratory tract or the endotracheal tube of the lung with the mortality of 30 to 40%.
Complication
1. Leptospirosis
Leptospirosis is a widespread zooanthroponosis that is prevalent in tropical regions due to the
favorable environmental survival conditions of its etiologic agent (Leptospira)(12).
2. Fetomaternal complications
Antenatal diagnosis and treatment of women with hereditary hemorrhagic
telangectasia and pulmonary arteriovenous malformations might prevent
potentially lifethreatening fetomaternal complications(13).
3. Pulmonary infection and respiratory failure
In the study of spinal cord injury (SCI) rats, pulmonary edema and hemorrhage were occurred in the early stage of SCI while the other organs were almost normal. And the location of lung edema and hemorrhage were the same as that of pulmonary infection(14).
4. Etc.
E.4. Treatments
Treatments depend on the diagnosis of each patient, if the underlined
cause is due to medication, then medicine has to be stopped.
1. Immediate treatment
According to the Intensive Care Nursery House Staff Manual immediate
treatment of P-Hem should include tracheal suction, oxygen and positive
pressure ventilation. To assist in decreasing P-Hem, mean
airway pressure should be increased, either by a relatively high PEEP (i.e., 6 to 10
cmH2O) or by high frequency ventilation(15). In the infants, reserachers
at suggested that current management of PH in VLBW infants includes
ventilatory support using high
positive end expiratory pressure, transfusion of blood and blood
products to support the circulation and correct any hemostatic or
coagulation defects and evaluation and treatment for patent ductus
arteriousus (PDA). These strategies are often ineffective in preventing
a poor outcome. rFVIIa is effective in controlling life-threatening
hemorrhage in patients with hemophilia A and B with inhibitors,
and in nonhemophiliacs with a variety of inherited or acquired
hemostatic defects including platelet disorders, liver disease and von
Willebrand's disease.(15a)
2. Embolization - Interventional treatment of pulmonary arteriovenous malformations
Acording to the study of Dr. Andersen PE and Dr. Kjeldsen AD. at the Odense University Hospital " Pulmonary
arteriovenous malformations (PAVM) are congenital vascular
communications in the lungs. The generally accepted treatment strategy of first choice is
embolization of the afferent arteries to the arteriovenous
malformations. It is a minimally invasive procedure and at the same time
a lung
preserving treatment with a very high technical success, high
effectiveness and low morbidity and mortality. Embolization prevents
cerebral stroke and abscess as well as pulmonary haemorrhage
and further raises the functional level. Embolization is a
well-established method of treating PAVM, with a significant effect on
oxygenation of the blood. Screening for PAVM in patients at risk is
recommended, especially in patients with HHT(16).
3. Corticosteroids
There is a report of a patient suffered from acute
glomerulonephritis with modest renal impairment and life-threatening
pulmonary hemorrhage. The pulmonary hemorrhage caused severe hypoxia
that necessitated artificial ventilation. As a last resort, 1 g/day of
methylprednisolone was administered intravenously. Rapid cessation of
pulmonary hemorrhage ensued with clearing of the lungs fields. the
suggestion of large doses of glucocorticosteroids should be administered
to patients with life-threatening pulmonary hemorrhage before
considering bilateral nephrectomy, especially if the renal function is
still adequate. Bilateral nephrectomy is an irreversible approach and,
as with massive doses of steroids, has yet to be proved to be a
consistently effective mode of therapy(17).
4. Etc.
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Sources
(12) http://saithan.net/pulmonary%20and%20sys%20disease/Pulmonary%20complications%20of%20leptospirosis.pdf
(13) http://ape.med.miami.edu/Doc/Resident%20Web%20Site%20Articles/Other%20diseases/Hereditary%20Hemorrhagic%20Telangiectasias/OB%20article%20+%20pulmAVMs.pdf
(14) http://www.ncbi.nlm.nih.gov/pubmed/22683446
(15) http://www.ucsfbenioffchildrens.org/pdf/manuals/29_PulmHemorrhage.pdf
(15a) http://www.nature.com/jp/journal/v22/n8/full/7210787a.html
(16) http://www.ncbi.nlm.nih.gov/pubmed/21160695
(17) http://annals.org/article.aspx?articleid=689575
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