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Adult respiratory distress syndrome in neutropenic patients

  • Marc D. Laufe
    Affiliations
    Pulmonary and Critical Care Medicine Division, Department of Internal Medicine, the Department of Pathology, and the Department of Epidemiology, School of Public Health, University of Michigan Medical Center, Ann Arbor, Michigan, USA
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  • Richard H. Simon
    Correspondence
    Requests for reprints should be addressed to Dr. Richard H. Simon, Pulmonary and Critical Care Medicine Division, 3916 Taubman Center, University of Michigan Medical Center, Ann Arbor, Michigan 48109.
    Affiliations
    Pulmonary and Critical Care Medicine Division, Department of Internal Medicine, the Department of Pathology, and the Department of Epidemiology, School of Public Health, University of Michigan Medical Center, Ann Arbor, Michigan, USA
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  • Andrew Flint
    Affiliations
    Pulmonary and Critical Care Medicine Division, Department of Internal Medicine, the Department of Pathology, and the Department of Epidemiology, School of Public Health, University of Michigan Medical Center, Ann Arbor, Michigan, USA
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  • Jacob B. Keller
    Affiliations
    Pulmonary and Critical Care Medicine Division, Department of Internal Medicine, the Department of Pathology, and the Department of Epidemiology, School of Public Health, University of Michigan Medical Center, Ann Arbor, Michigan, USA
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      Abstract

      The precise pathophysiologic mechanisms that cause the adult respiratory distress syndrome are unknown. Indirect evidence from human studies and extrapolations from animal models have suggested that phagocytic neutrophils are important in the pathogenesis of this disease. To further evaluate the role of neutrophils, the frequency of neutropenia in 18 bacteremic patients who had the adult respiratory distress syndrome was compared with that in a control group who had bacteremia alone. Three of 18 patients in the group with the adult respiratory distress syndrome were neutropenic as opposed to one of 18 in the control group (p >0.6). Histologic examination of the lungs from two patients with the adult respiratory distress syndrome and neutropenia demonstrated the absence of neutrophils. It is likely that there are many pathways that lead to the adult respiratory distress syndrome. Although neutrophils may be involved in some of these processes, this study demonstrates that neutrophils are not required for the development of the syndrome. In the appropriate clinical setting, the diagnosis of the adult respiratory distress syndrome should not be excluded solely because of neutropenia.
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      References

        • Ashbaugh DG
        • Bigelow DB
        • Petty TL
        • Levine BE
        Acute respiratory distress in adults.
        Lancet. 1967; II: 319-323
        • Tate RM
        • Repine JE
        Neutrophils and the adult respiratory distress syndrome.
        Am Rev Respir Dis. 1983; 128: 552-559
        • Bachofen M
        • Weibel ER
        Alterations of the gas exchange apparatus in adult respiratory insufficiency associated with septicemia.
        Am Rev Respir Dis. 1977; 116: 589-615
        • Lee CT
        • Fein AM
        • Lippmann M
        • Holtzman H
        • Kimbel P
        • Weinbaum G
        Elastolytic activity in pulmonary lavage fluid from patients with adult respiratory distress syndrome.
        N Engl J Med. 1981; 304: 192-196
        • McGuire WM
        • Spragg RG
        • Cohen AB
        Studies on the pathogenesis of the adult respiratory distress syndrome.
        J Clin Invest. 1982; 69: 543-553
        • Zimmerman GA
        • Renzetti AD
        • Hill HR
        Functional and metabolic activity of granulocytes from patients with the adult respiratory distress syndrome.
        Am Rev Respir Dis. 1983; 127: 290-300
        • Weiss SJ
        • Lobuglio AF
        Biology of disease.
        in: Phagocyticgenerated oxygen metabolites and cellular injury. Lab Invest. 47. 1982: 5-18
        • Johnson KJ
        • Ward PA
        Role of oxygen metabolites in immune complex injury of lung.
        J Immunol. 1981; 126: 2365-2369
        • Till GO
        • Johnson KJ
        • Kunkel R
        • Ward PA
        Intravascular activation of complement and acute lung injury.
        in: Dependency on neutrophils and toxic oxygen metabolites. J Clin Invest. 69. 1982: 1126-1135
        • Hohn DC
        • Meyers AJ
        • Gherini ST
        • Bechman A
        • Markisa RE
        • Churg AM
        Production of acute pulmonary injury by leukocytes and activated complement.
        Surgery. 1980; 88: 48-57
        • Hosea S
        • Brown E
        • Hammer C
        • Frank M
        Role of complement activation in a model of adult respiratory distress syndrome.
        J Clin Invest. 1980; 66: 375-382
        • Flick MR
        • Perel A
        • Staub NC
        Leukocytes are required for increased lung microvascular permeability after microembolization in sheep.
        Circ Res. 1981; 48: 344-351
        • Armitage P
        Statistical methods in medical research.
        in: J Wiley and Sons, New York1971: 116-118
        • Armitage P
        Statistical methods in medical research.
        in: J Wiley and Sons, New York1971: 135-138
        • Mood AM
        • Graybill FA
        • Boes DC
        Introduction to the theory of statistics.
        in: McGraw-Hill, New York1974: 389-393
        • Thommasen HV
        • Russel JA
        • Boyko WJ
        • Hogg JC
        Transient leucopenia associated with adult respiratory distress syndrome.
        Lancet. 1984; I: 809-812
        • Bone RC
        Treatment of severe hypoxemia due to the adult respiratory distress syndrome.
        Arch Intern Med. 1980; 140: 85-89
        • Rinaldo J
        • Rogers RM
        Adult respiratory distress syndrome: changing concepts of lung injury and repair.
        N Engl J Med. 1982; 306: 900-909
        • Crandall ED
        • Staub NC
        • Goldberg HS
        • Effros RM
        Recent developments in pulmonary edema.
        Ann Intern Med. 1983; 99: 808-822
        • Guyton AC
        • Moffatt DS
        Role of surface tension and surfactant in the transepithelial movement of fluid and in the development of pulmonary edema.
        Prog Respir Res. 1981; 15: 62-75
        • Fairman RP
        • Glauser FL
        • Falls R
        Increases in lung lymph and albumin clearance with ethchlorvynol.
        J Appl Physiol. 1981; 50: 1151-1155