1. OVERVIEW AND DEFINITIONS
Relatively uncommon but potentially serious and life threatening
problem in children. Not a disease in itself but presenting symptom of an
underlying condition, of which bleeding is usually the presenting, if not
the only, symptom.
Severity of the bleeding not necessarily correlates with
the severity or seriousness of the underlying problem. Multiple unrelated
problems can have bleeding as part of their symptom complex, thus differential
diagnosis based solely on the presence and severity of bleeding can be quite
difficult.
When bleeding results in death it is almost always
because of asphyxiation and not from exsanguination. Therefore, maintaining
adequate airway and ventilation is crucial.
Source of bleeding usually difficult to pinpoint. Eroded
airway vessel, diffuse parenchymal bleed, congenital malformation (not necessarily
vascular), traumatized airway or lung parenchyma can be potential sources
of bleeding.
Data on incidence in children is lacking. In neonates occurrence
of pulmonary hemorrhage has been estimated at 0.7 to 3.8 events per 1,000
live births.
Pulmonary Hemorrhage: Bleeding that occurs within the lungs and that has a parenchymal
or bonchial source. May or may not lead to hemoptysis.
Depending on source, children will not always be able to cough up all the
blood, even more if source is parenchymal.
Pulmonary Hemosiderosis: Accumulation of iron, in the form of hemosiderin,
within alveolar macrophages. Always the result of bleeding into the lungs,
and more likely after bleeding at the alveolar level than
at the large airway level.
Hemoptysis: Expectoration of fresh blood derived from the lungs. Blood is coughed out in variable amounts, usually the patient will mention a 'mouthful' or 1 to 2 ounces of bright red, foamy blood being spit out.
Assessment of severity of hemoptysis can be based on amount of blood lost during episode:
Mild Less than 60 cc of blood lost for the whole episode. Massive More than 200 cc of blood lost in a 24 hour period. Life-threatening More than 120 cc of blood lost in an hour.
These criteria applies mostly to older children and adolescents.
At any age, bleeding that results in respiratory distress and altered gas
exchange is life-threatening, regardless of amount of blood (remember, amount
of blood expectorated not necessarily represents the total amount lost into
the airspaces).
Hemoptoic expectoration: Coughing out of sputum with streaks of blood mixed with it. This
is not hemoptysis.
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Where is it from?