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Diagnostic Evaluation of Pulmonary Disease Following Hematopoietic Stem Cell Transplantation

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Pulmonary and Critical Care Considerations of Hematopoietic Stem Cell Transplantation

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Abstract

Pulmonary diseases are frequent complications following hematopoietic stem cell transplantation (HSCT). They can be infectious and noninfectious, sometimes combined, and occur before and after engraftment. They may involve the bronchi, alveoli, and capillary vessels. They can occur after autologous and allogeneic HSCT with similarities but also differences which depend on various factors. Clinical presentations are diverse, and an accurate and timely differential diagnosis is essential.

The diagnostic evaluation should be systematic, from the least invasive to the most invasive, with pretest probability and risk over benefit ratio in mind. Diagnostics include complete cell count with differential, blood culture, nasopharyngeal swab, and urine antigens. Serum can be tested for viral and fungal markers, antinuclear antibodies, extractable nuclear antigen antibodies, and vasculitis panel. Pro-brain natriuretic peptide and echocardiogram may be helpful. Imaging may include chest radiograph and chest computed tomography. Bronchoscopy with bronchoalveolar lavage may be useful in challenging or unresolved situations. Tissue biopsy is rarely indicated.

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Authors and Affiliations

  1. Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA

    Philippe R. Bauer

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Correspondence to Philippe R. Bauer .

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  1. Pulmonary and Critical Care Medicine, Wayne State University, Detroit, MI, USA

    Ayman O. Soubani

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Bauer, P.R. (2023). Diagnostic Evaluation of Pulmonary Disease Following Hematopoietic Stem Cell Transplantation. In: Soubani, A.O. (eds) Pulmonary and Critical Care Considerations of Hematopoietic Stem Cell Transplantation. Springer, Cham. https://doi.org/10.1007/978-3-031-28797-8_5

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  • DOI: https://doi.org/10.1007/978-3-031-28797-8_5

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