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Alveolar hemorrhage syndromes: Idiopathic Pulmonary Hemosiderosis

Idiopathic pulmonary hemosiderosis is a subset of the pulmonary hemorrhage syndromes that involves anemia, infiltrates seen on chest x-ray, and some children will cough up blood or bloody mucus, but this is not always seen because some children swallow the secretions. Bronchoalveolar lavage (BAL) contains hemosiderin-laden macrophages or gastric aspirates. The onset can be acute and life-threatening which requires intubation and mechanical ventilation. Lung biopsy is rarely used in these patients.

It is important to differentiate between pulmonary hemosiderosis and pulmonary capillaritis, because the treatment and course of the disease is quite different. Pulmonary capillaritis is exacerbated by an over-active immune response so antibody titers should be performed to measure the immune response.

Most cases of idiopathic pulmonary hemosiderosis can be managed with corticosteroids.