Pulmonary Complications of Haematologic Disorders

Chapter
Part of the Respiratory Medicine book series (RM)

Abstract

Sickle cell disease (SCD), a haemolytic anaemia, is the most common inherited disorder affecting African and Caribbean populations. In young children obstructive lung function abnormalities are common, but restrictive lung function abnormalities become more prominent with increasing age. The rate of decline in lung function is related to age, being commoner in younger children in whom acute chest syndrome episodes are more common. Iron overload, due to a variety of conditions including thalassaemia, can cause damage to the lungs resulting in lung function abnormalities and respiratory morbidity. Approximately 40% of survivors of childhood leukaemia have some degree of abnormality on pulmonary function testing, but only 10–25% of children are symptomatic reporting cough or mild dyspnea; this is as a consequence of chemotherapy and irradiation. Children who are anaemic have a reduction in the amount of haemoglobin in the blood which reduces their oxygen-carrying capacity. Iron deficiency may also reduce the deformability of red blood cells, compromising passage through capillary beds and therefore reducing oxygen delivery. Inherited bleeding disorders, such as haemophilia and von Willebrand’s disease, rarely cause alveolar haemorrhage, but patients may experience bleeding into the pleural cavity or mediastinum with consequent respiratory distress and hypoxaemia. Pulmonary embolism is a rare event in children. Risk factors include congenital cardiac disease, presence of an indwelling central venous catheter and systemic infection. Oral contraceptive use is increasingly recognised as an important risk factor in adolescent girls.

Keywords

Sickle cell disease Thalassaemia Anaemia Leukaemia Hyperviscosity Bleeding disorders 

Abbreviations

2,3-DPG

2,3-diphosphoglyceric acid

ACS

Acute chest syndrome

AHR

Airway hyperresponsiveness

All

Acute lymphoblastic leukaemia

AML

Acute myeloid leukaemia

COHb

Carboxyhaemoglobin

CT

Computerised tomography

CTEPH

Chronic thromboembolic pulmonary hypertension

DAH

Diffuse alveolar haemorrhage

DLCO

Diffusing capacity of the lung

FEF75

Forced expiratory flow at 75% of vital capacity

FEV1

Forced expiratory volume at one minute

FOE

Fractional oxygen extraction

FVC

Forced vital capacity

GHVD

Graft-versus-host disease

HbF

Foetal haemoglobin

HbSC

Haemoglobin sickle cell disease

HbSS

Sickle cell anaemia

HbSβthal

Sickle β0- and β+-thalassaemia

HO-1

Heme oxygenase-1

HSCT

Haematopoietic stem cell transplantation

IPH

Idiopathic pulmonary haemosiderosis

NO

Nitric oxide

OSAS

Obstructive sleep apnoea syndrome

PE

Pulmonary embolism

PEF

Peak expiratory flow

SCD

Sickle cell disease

SDB

Sleep-disordered breathing

SPLA2

Pulmonary secretory phospholipase A2

TLC

Total lung capacity

TRV

Tricuspid regurgitant jet velocity

VCAM-1

Vascular cell adhesion molecule

VOC

Vaso-occlusive crisis

VTE

Venous thromboembolism

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Key Articles

  1. Lunt A, McGhee E, Sylvester K, Rafferty GF, Dick M, Rees D, et al. Longitudinal assessment of lung function in children with sickle cell disease. Pediatr Pulmonol. 2016;51:717–23.PubMedCrossRefGoogle Scholar
  2. Koumbourlis A, Lee DJ, Lee A. Longitudinal changes in lung function and somatic growth in children with sickle cell disease. Pediatr Pulmonol. 2007;42:483–8.PubMedCrossRefGoogle Scholar
  3. Knight-Madden JM, Forrester TS, Lewis NA, Greenough A. Asthma in children with sickle cell disease and its association with acute chest syndrome. Thorax. 2005;60:206–10.PubMedPubMedCentralCrossRefGoogle Scholar
  4. Chaudry RA, Rosenthal M, Bush A, Crowley S. Reduced forced expiratory flow but not increased exhaled nitric oxide or airway responsiveness to methacholine characterises paediatric sickle cell airway disease. Thorax. 2014;69:580–5.PubMedCrossRefGoogle Scholar
  5. Lunt A, McGhee E, Robinson P, Rees D, Height S, Greenough A. Lung function, transfusion, pulmonary capillary blood volume and sickle cell disease. Respir Physiol Neurobiol. 2016;222:6–10.PubMedCrossRefGoogle Scholar
  6. Li AM, Chan D, Li CK, Wong E, Chan YL, Fok TF. Respiratory function in patients with thalassaemia major: relation with iron overload. Arch Dis Child. 2002;87:328–30.PubMedPubMedCentralCrossRefGoogle Scholar
  7. Hamed AES, Ragab IA, Kamel TB, Abd-El-Gawad AOA. Effect of using bedside leukocyte filter on pulmonary functions in patients with thalassemia major. Pediatr Hematol Oncol. 2013;30:761–7.CrossRefGoogle Scholar
  8. Sohn EY, Noetzli LJ, Gera A, Kato R, Coates TD, Harmatz P, et al. Pulmonary function in thalassaemia major and its correlation with body iron stores. Br J Haematol. 2011;155:102–5.PubMedPubMedCentralCrossRefGoogle Scholar
  9. Redaelli A, Laskin BL, Stephens JM, Botteman MF, Pashos CL. A systematic literature review of the clinical and epidemiological burden of acute lymphoblastic leukaemia (ALL). Eur J Cancer Care (Engl). 2005;14:53–62.CrossRefGoogle Scholar
  10. Rossi SE, Erasmus JJ, McAdams HP, Sporn TA, Goodman PC. Pulmonary drug toxicity: radiologic and pathologic manifestations. Radiographics. 2000;20:1245–59.PubMedCrossRefGoogle Scholar
  11. Fredrickson LK, Bell EF, Cress GA, Johnson KJ, Zimmerman MB, Mahoney LT, et al. Acute physiological effects of packed red blood cell transfusion in preterm infants with different degrees of anaemia. Arch Dis Child Fetal Neonatal Ed. 2011;96:F249–53.PubMedCrossRefGoogle Scholar
  12. Moschovis PP, Banajeh S, MacLeod WB, Saha S, Hayden D, Christiani DC, et al. Childhood anemia at high altitude: risk factors for poor outcomes in severe pneumonia. Pediatrics. 2013;132:e1156–62.PubMedPubMedCentralCrossRefGoogle Scholar
  13. von Drygalski A, Biller J. Anemia in cystic fibrosis: incidence, mechanisms and association with pulmonary function and vitamin deficiency. Nutr Clin Pract. 2008;23:557–63.CrossRefGoogle Scholar
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Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  1. 1.Department of Women and Children’s HealthSchool of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College LondonLondonUK
  2. 2.Division of Asthma, Allergy and Lung BiologyMRC and Asthma UK Centre in Allergic Mechanisms of Asthma, King’s College LondonLondonUK

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