© 2002 Archives of Disease in Childhood
CASE REPORT
Pitfalls in the diagnosis of idiopathic pulmonary haemosiderosis
Division of Pediatric Hematology/Oncology, Department of Medicine, Chang Gung Children's Hospital, Taoyuan, Taiwan
Correspondence to:
Correspondence to:
Dr I-J Hung, Head, Division of Pediatric Hematology/Oncology, Department of Medicine, Chang Gung Children's Hospital, 5 Fu-Hsin Street, Kweishan 333, Taoyuan, Taiwan;
yao{at}adm.cgmh.org.tw
Idiopathic pulmonary haemosiderosis is a very rare but devastating disorder. Diagnosis is sometimes difficult and the clinical course exceedingly variable, as illustrated by this report of a girl, aged 2 years 4 months, with severe iron deficiency anaemia. There was no response to iron therapy and transfusions. Sustained and striking reticulocytosis associated with low haptoglobin mimicked haemolytic anaemia. Positive faecal blood test was documented after repeated testing. There were no pulmonary symptoms. A chest radiograph showed bilateral diffuse alveolar infiltrates. Bronchoalveolar lavage fluid showed numerous siderophages. High resolution computed tomography of the thorax revealed early pulmonary fibrotic changes. Recurrent reticulocytosis appeared to be a very useful sign of recurrent bleeding episodes.
Keywords: anaemia; idiopathic pulmonary haemosiderosis; iron deficiency anaemia; haemolytic
Abbreviations: ANCA, antineutrophil cytoplasmic antibody; AST, aspartate aminotransferase; BAL, bronchoalveolar lavage; BUN, blood urea nitrogen; IDA, iron deficiency anaemia; IPH, idiopathic pulmonary haemosiderosis; NRBC, nucleated red blood cell; MCV, mean corpuscular volume; RAST, radioallergosorbent test; RBC, red blood cell; WBC, white blood cell
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