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Acute Pulmonary Manifestations of Hematologic Malignancies

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Hematologic Abnormalities and Acute Lung Syndromes

Part of the book series: Respiratory Medicine ((RM))

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Abstract

Acute pulmonary manifestations unfortunately often present as serious complications for patients with hematologic malignancies. The timing of the pulmonary illness in relation to the diagnosis, treatment, and immunological status of the patient is of utmost importance when attempting to determine a differential diagnosis. Such complications can generally be classified as infectious versus noninfectious (Table 7.1). Infectious complications require prompt anti-infective treatments while utilizing investigative studies such as computed tomography (CT), serologic analysis, sputum analysis and at times bronchoscopy with bronchoalveolar lavage (BAL). A study found the causative agents to be a bacterial organism in 41.3 % of patients, while fungi affected 23.8 % and viruses 28.6 % (Kim et al., Ann Hematol. 94:153–159, 2015). The infectious complications of hematological malignancies such as bacterial, viral, and fungal pneumonias are detailed below. Noninfectious etiologies such as pulmonary edema, pulmonary hemorrhage, pulmonary leukostasis, and treatment related illnesses can cause significant morbidity and mortality as well. Often a thorough history and physical of the patient can illuminate the cause and subsequent required treatments in a patient with a hematologic malignancy that is presenting with acute pulmonary symptoms.

Patients with hematologic malignancies can present with life threatening acute pulmonary disease. Prompt recognition and treatment of these conditions are imperative in reducing morbidity and mortality. Patients presenting with dyspnea, cough, or acute respiratory failure in the setting of a hematologic malignancy require thorough investigation by clinical history and physical exam. The type of malignancy, treatment of the malignancy, and the patient’s time course in the disease process provide invaluable clues to the etiology (Fig. 7.1). Additionally, the patient’s smoking status, possible environmental exposures, and the extent of prior underlying lung disease must be known. Often, a thorough history and exam can lead to the diagnosis that is later confirmed by appropriate testing.

The acute pulmonary manifestations commonly associated with hematologic malignancies can generally be classified as infectious versus noninfectious (Table 7.1). The infectious complications such as bacterial, viral and fungal pneumonias are detailed below. Noninfectious pulmonary manifestations include pulmonary hemorrhage, pulmonary edema, complications from treatments, and complications following hematopoietic stem cell transplantation (HSCT) frequently cause morbidity for these patients and are discussed in this chapter.

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Author information

Authors and Affiliations

  1. Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, The Ohio State University, Columbus, OH, USA

    Andra Fee-Mulhearn DO, MPH

  2. Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, The Ohio State University, Columbus, OH, USA

    Patrick Nana-Sinkam MD

  3. Division of Medical Oncology, The Ohio State University, Columbus, OH, USA

    Patrick Nana-Sinkam MD

  4. James Thoracic Oncology Center, The Ohio State University, Columbus, OH, USA

    Patrick Nana-Sinkam MD

  5. Faculty Advancement, Mentorship and Engagement, Center for FAME, The Ohio State University, Columbus, OH, USA

    Patrick Nana-Sinkam MD

Authors
  1. Andra Fee-Mulhearn DO, MPH
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  2. Patrick Nana-Sinkam MD
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Correspondence to Patrick Nana-Sinkam MD .

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Editors and Affiliations

  1. Division of Pulmonary, Allergy, and Critical Care Medicine Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA

    Janet S. Lee

  2. Division of Pulmonary, Allergy, and Critical Care Medicine Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA

    Michael P. Donahoe

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Fee-Mulhearn, A., Nana-Sinkam, P. (2017). Acute Pulmonary Manifestations of Hematologic Malignancies. In: Lee, J., Donahoe, M. (eds) Hematologic Abnormalities and Acute Lung Syndromes. Respiratory Medicine. Humana Press, Cham. https://doi.org/10.1007/978-3-319-41912-1_7

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  • DOI: https://doi.org/10.1007/978-3-319-41912-1_7

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  • Publisher Name: Humana Press, Cham

  • Print ISBN: 978-3-319-41910-7

  • Online ISBN: 978-3-319-41912-1

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