Diffuse alveolar hemorrhage with onset in infancy: a retrospective single-center study

Diffuse alveolar hemorrhage with onset in infancy: a retrospective single-center study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Diffuse alveolar hemorrhage with onset in infancy: a retrospective single-center study Xiao Wu, Jing Liu, Fuce Lu, Xun Chen, Guangmin Nong, Chunyan Li, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8497779/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 7 You are reading this latest preprint version Abstract Background To explore the clinical features, treatments and outcomes of diffuse alveolar hemorrhage (DAH) with onset in infancy with the aim of extending clinician’s awareness and improving the diagnostic and therapeutic accuracy for the disease. Methods The cases of DAH with onset in infancy, who had been hospitalized in the Department of Pediatrics at the First Affiliated Hospital of Guangxi Medical University from January 2012 and April 2025 were included. A retrospective study was conducted. Results 1. A total of 285 pediatric cases of DAH were included, in which 26 cases (9.1%) presented with onset in infancy. 2.Of the cases with onset in infancy, the median age at onset were 8.0 (4.8, 10.3) months. The median age at diagnosis were 11.0 (6.8, 21.8) months. The median duration from disease onset to diagnosis were 2.5 (1.0, 12.0) months. 3. At onset of the disease, the most common clinical manifestation was anemia which was found in 24 cases (92.3%) and the following clinical manifestations included cough in 14 cases (53.8%), hemoptysis in 9 cases (34.6%), dyspnea in 9 cases (34.6%), haematemesis in 2 cases (7.7%) and melena in 1 case (3.8%). Respiratory failure was found in 6 cases (23.12%). 4. Twenty three cases (88.5%) had received glucocorticoids treatment and 13 cases (50.0%) had received immunosuppressants treatment. 5. Assess of the clinical course were available in 21 cases, in which 18 cases (85.7%) presented a chronic and recurrent clinical course and 3 cases (14.3%) presented a transient clinical course. 5. By the end of April 2025, there were 20 cases with available follow-up, in which 1 case (5.0%) died and 19 cases (95.0%) survived. Of these 19 survived cases, 4 cases (21.1%) had decreased endurance activity. Follow-up chest CT revealed pulmonary fibrosis in 1 cases (3.8%). Conclusions DAH with onset in infancy was uncommon. It usually presented a chronic and recurrent clinical course. After treatments, death was less common, whereas pulmonary fibrosis or decreased endurance activity might develop. diffuse alveolar hemorrhage infancy anemia glucocorticoid clinical course Figures Figure 1 Figure 2 Background Diffuse alveolar hemorrhage (DAH) is a relatively rare and severe life-threatening clinical syndrome in children [ 1 ]. The majority of the cases having reported in the literature had onset beyond infancy [ 2 ]. Whereas, the cases with onset in infancy have been rarely reported. Until now, only about 20 cases have been reported in the literature [ 2 – 8 ]. In the children with onset beyond infancy, DAH has been gradually well recognized. It was found to be caused by a wide variety of disorders and usually presented a chronic course with high mortality [ 2 ]. Whereas, it has not been recognized well in DAH with onset in infancy due to the rarity of the disease. In view of this, this present study is intended to explore the clinical features, treatments and outcomes of DAH with onset in infancy with the aim of extending clinician’s awareness and improving the diagnostic and therapeutic accuracy for this disease. Methods Subjects In this study, we screened the cases of DAH with onset in infancy from our pediatric DAH database between January 2012 and April 2025. (Fig. 1 ) The cases caused by the definite non-immune disorders such as congenital heart diseases, coagulation disorders, pulmonary infections, acute respiratory distress syndrome, inhalation injury were excluded. All the subjects agreed to participate this study. Diagnostic criteria for DAH DAH was diagnosed when the subjects fulfilled all the following conditions ⑴ presence of respiratory symptoms (dyspnea, hemoptysis or cough) or iron deficiency anemia; ⑵ diffuse pulmonary infiltrates (ground-glass opacities or consolidations) on the chest CT; ⑶ presence of hemosiderin laden macrophages in the bronchoalveolar lavage fluid (BALF) or lung tissue specimen [ 1 ]. Diagnostic criteria for anemia The diagnostic criteria for anemia was defined as hemoglobin (Hb) level less than 120g/L in children greater or equal to 6 year-old, less than 110g/L in children greater or equal to 6 months and less than 6 year-old, less than 100g/L in children greater or equal to 4 months and less than 6 months, less than 90g/L in children greater or equal to 1 month and less than 4 months [ 9 , 10 ]. Definition for clinical course A chronic and recurrent clinical course was referred as disease duration of more than 6 months. A transient clinical course was referred as disease duration of less or equal to 6 months and absence of recurrence for more than 2 years. Methods A retrospective, observational study was conducted. Clinical data were collected by reviewing the medical records including the age of onset, the age of diagnosis, gender, etiologies, clinical features, treatment strategies and outcomes. Statistical analysis Statistical analysis was performed using SPSS 25.0 soft. Measurement data were expressed as medians (25th-75th percentile). Counting data were expressed as count (percentage). Results General information A total of 285 pediatric cases of DAH were included, in which 26 cases (9.1%) presented with onset in infancy. (Fig. 1 ) Of the cases with onset in infancy, there were 9 male and 17 female. All the cases were considered as idiopathic without any identifiable etiologies. One case had performed the whole-exome sequencing to further screen the variant genes associated with DAH, but revealed a negative result. The median age at onset were 8.0 (4.8, 10.3) months. The median age at diagnosis were 11.0 (6.8, 21.8) months. The median duration from disease onset to diagnosis were 2.5 (1.0, 12.0) months. (Table 1 ) Table 1 Clinical data of diffuse alveolar hemorrhage with onset in infancy No. Age at onset Age at diagnosis Gender Clinical manifestations at onset Lowest Hb level during the course of the disease RF ECHO ANA Anti-GBM ANCA Complements Duration from the last chest CT to the disease onset Duration from disease onset to the last follow-up Glucocorticoids Immunosuppressants Clinical course Outcomes 1 10 10 M Anemia, cough, dyspnea 44.0 Y Y N N N C 4 40 42 Y c AZA C S 2 10 33 F Anemia, dyspnea 42.0 N Y 1:100 N N N 39 44 Y HCQ, Thal C S d 3 6 6 F Hemoptysis, anemia 56.0 N Y N N N ND 18 52 Y ND C S 4 9 12 F Hemoptysis, anemia, cough 75.0 N Y N P N N 12 54 Y MTX C S 5 1 1 F Hemoptysis, anemia, cough 92.0 N Y ND ND ND N 24 73 ND ND T S 6 6 7 M Cough, dyspnea 115.9 Y a N ND ND ND N 1 75 N N T S 7 5 6 M Anemia, cough, dyspnea 68.0 Y a N 1:100 N N ND 2 76 Y ND T S 8 3 11 F Hemoptysis, anemia, cough 25.0 N Y ND N ND N 71 79 Y AZA C S 9 9 42 F Anemia, dyspnea 54.0 Y Y b N N N C 3/4 32 32 Y ND C D 10 5 7 F Anemia 44.8 N Y 1:100 N N ND 42 90 Y MTX, HCQ C S 11 6 7 M Hemoptysis, anemia, cough 101.2 N Y 1:100 P N ND 1 ND ND ND ND ND 12 11 17 M Anemia 45.0 N N N N N N 64 96 Y HCQ, MTX C S 13 7 8 M Haematemesis, anemia, cough 99.3 N Y N N N N 94 97 Y AZA, MMF C S 14 12 15 F Anemia, dyspnea 23.0 N Y N N N C 4 11 ND Y MTX C ND 15 5 60 F Hemoptysis, anemia, 63.0 N Y N N 1:10 N 106 108 Y c MTX, HCQ, Thal C S 16 4 10 F Hemoptysis, anemia, cough 66.0 N Y ND N ND N 34 ND Y ND C ND 17 11 46 F Anemia 44.2 N Y 1:100 N N N 89 110 Y c MTX, AZA C S 18 e 2 3 M Cough, dyspnea 112.4 Y Y b 1:100 P ND N 117 120 Y ND C S d 19 2 4 M Anemia, cough, dyspnea 99.3 Y N ND P ND ND 1 ND Y ND C ND 20 10 11 F Anemia 20.0 N N N N N C 4 3 ND Y ND ND ND 21 11 16 F Anemia 33.0 N Y N N N N 125 128 Y c MTX, HCQ C S d 22 3 4 F Haematemesis, melena, anemia 70.3 N N ND ND ND C 3/4 1 ND Y ND ND ND 23 9 27 F Hemoptysis, anemia, cough 48.0 N Y N N N N 37 131 Y AZA, MTX C S 24 11 17 M Anemia, cough, dyspnea 81.0 N N N N N ND 26 135 Y ND ND S 25 9 20 F Anemia, 44.0 N N N N N ND 26 153 Y ND ND S 26 11 72 F Hemoptysis, anemia, cough 53.0 N Y N N N C 4 105 175 Y MTX, AZA, HCQ C S d M , male; F , female; RF , respiratory failure; ECHO , echocardiography; S , survival; D , death; C , a chronic and recurrent clinical course; T , a transient clinical course; ND , not done; N , negative; Y , done; Hb , hemoglobin; AZA , azathioprine; MTX , methotrexate; HCQ , hydroxychloroquine; Thal , thalidomide; MMF , mycophenolate a: These cases needed invasive mechanical ventilation. b: ECHO revealed pulmonary arterial hypertension in these cases. c: These cases tapered off glucocorticoids successfully according to medical advice. d: These cases had decreased endurance activity. e: This case developed pulmonary fibrosis. He performed the whole-exome sequencing, but revealed a negative result. Clinical manifestations At onset of the disease, the most common clinical manifestation was anemia, which was found in 24 cases (92.3%). The following clinical manifestations included cough in 14 cases (53.8%), hemoptysis in 9 cases (34.6%), dyspnea in 9 cases (34.6%), haematemesis in 2 cases (7.7%) and melena in 1 casese (3.8%). (Table 1 ) During the course of the disease, the median levels of the lowest Hb were 55.0 (44.0, 83.8) g/L. Respiratory failure was found in 6 cases (23.1%), in which 2 cases (7.8%) needed invasive mechanical ventilation. Total 18 cases had performed echocardiography, in which pulmonary arterial hypertension was found in 2 cases (11.1%). Two case (7.7%) had renal involvement presenting as hematuia and/or proteinuria, but without impaired kidney function. (Table 1 ) Autoantibodies and complements detection During the course of the disease, 23 cases (88.5%) had performed autoantibodies including ANA, ANCA and anti-GBM detection, in which 9 cases (39.1%) revealed positive findings. Of these, 20 cases had performed ANA detection, in which 6 cases (30.0%) revealed a positive result. Twenty three cases had performed anti-GBM detection, in which 4 cases (17.4%) revealed a positive result. Nineteen cases had performed ANCA detection, in which 1 case (5.3%) revealed a positive result. Nineteen cases (73.1%) had performed complements detection, in which 6 cases (31.6%) revealed a decline of complement levels (C3 and/or C4). (Table 1 ) Treatment strategies Twenty three cases (88.5%) had received glucocorticoids treatment and 13 cases (50.0%) had received immunosuppressants treatment. The immunosuppressants having administrated in these cases included methotrexate (MTX) in 9 cases, hydroxychloroquine (HCQ) in 6 cases, azathiopine (AZA) in 6 cases, thalidomide (Thal) in 2 cases and mycophenolate (MMF) in 1 case. Of note, 4 cases (15.4%) tapered off glucocorticoids successfully according to medical advice, but still needed immunosuppressants treatment. The duration of administration of glucocorticoids in these 4 cases were 40.0, 78.0, 89.0 and 106.0 months respectively. (Table 1 ) Disease course and outcome The clinical course couldn’t been classified due to lack of enough information in 5 cases. Of the rest 21 cases, 18 cases (85.7%) presented a chronic and recurrent clinical course and 3 cases (14.3%) presented a transient clinical course. (Table 1 ) All the cases had performed chest CT examination. The median duration from the last chest CT to the disease onset were 33.0 (9.0, 75.5) months. Follow-up chest CT revealed pulmonary fibrosis in 1 cases (3.8%). (Table 1 , Fig. 2 ) By the end of April 2025, there were 20 cases with available follow-up, in which 1 case (5.0%) died and 19 cases (95.0%) survived. Of these 19 survived cases, the median duration from disease onset to the last follow-up were 93.0 (58.8, 126.0) months and 4 cases (21.1%) had decreased endurance activity. (Table 1 ) Discussion DAH is a relatively rare disease in children and can be caused by a wide variety of etiologies. Onset of DAH may occur at all ages, whereas it is relatively rare in infancy. Until now, there has been not many systematic researches on DAH in children. The first article involving a multi-center study of DAH in children was reported in 2023, which was from the European network for translational research in children’s and adult interstitial lung disease (Cost Action CA16125) and chILDEU CRC (the European Research Collaboration for Children’s Interstitial Lung Disease) [ 2 ]. In this study, total 124 cases were included, whereas the cases with onset in infancy were less than 5 cases and the median age at onset was 5 year-old [ 2 ]. According to statistics, the cases of DAH with onset in infancy having reported in the literature were only about 20 cases [ 2 – 8 ]. In view of this, we conducted this study. In this study, total 26 cases of DAH with onset in infancy were included. To our knowledge, this present study comprises the largest sample size currently analyzed for DAH with onset in infancy. Due to the rarity of the disease and a relatively low clinical awareness, there is usually a delay in diagnosis of DAH in clinic. According to the literature, the median diagnostic delay in DAH in children were 2.0 months [ 2 ]. To infants, it seems to be a greater challenge due to the poor expressive ability. In this study, the median diagnostic delay in DAH with onset in infancy were 2.5 months, which was similar to the findings in the cases with DAH in children as mentioned above. This is likely due to the raised clinical awareness of this disease in our clinical center. The classical triad of clinical features of DAH includes hemoptysis, diffuse parenchymal infiltrates on chest imaging and iron deficiency anemia [ 11 ]. Whereas, the classical triad of clinical features of DAH is uncommon. This might be partly due to the low incidence of hemoptysis in cases with DAH in children [ 2 ]. In this study, hemoptysis was found to be more uncommon in the DAH with onset in infancy, in which hemoptysis was only found in about 1/3 of the cases. In fact, the most frequent clinical presentations of DAH in children was anemia [ 2 ]. Also, our results were consistent with this finding. Therefore, we should pay attention to DAH screening in the cases with anemia. DAH can be caused by a wide variety of etiologies including the immune disorders and non-immune disorders. In this study, all the cases were considered as idiopathic without any identifiable etiologies. It was noteworthy that 2 cases also had renal involvement, which demonstrated the possibility of underlying systemic diseases. In recent years, DAH has been found in the cases with gene variants diseases such as COPA syndrome, STING -associated vasculopathy with onset in infancy (SAVI), SFTPC related diseases [ 12 – 14 ], which might present onset of DAH in infancy. In this study, 1 case had performed the whole-exome sequencing to further screen the variant genes associated with DAH, but revealed a negative result. In the previous literature, idiopathic DAH was usually referred as idiopathic pulmonary hemosiderosis (IPH). Hereby, we collectively termed the cases as idiopathic DAH/IPH. Idiopathic DAH/IPH has been considered as non-immune mediated in the past [ 1 ]. Whereas, there was considerable evidence to support the immunologic association of the disease, as idiopathic DAH/IPH usually presented a good response to immunosuppressive therapy and positive autoantibodies were present in about 25% of the cases during the course of the disease [ 15 ]. In this study, our results were consistent with these findings. Besides that, about 1/3 of the cases in our study revealed decline of complements either, which also supported the immunologic association of the disease. As mentioned above, idiopathic DAH/IPH is considered and treated as an immune-mediated disease. Currently, glucocorticoids alone or in combination with other immunosuppressive regimens are often employed for the treatment of idiopathic DAH/IPH [ 15 ]. In this study, the majority of the cases chose use of glucocorticoids and showed a good response to glucocorticoids therapy in a short-term. The optimal duration of therapy with glucocorticoids is unknown. Recommendation in the literature suggested that glucocorticoids should be slowly tapered off until discontinuation, if the cases remains well-controlled for 12–18 months [ 15 ]. Unfortunately, recurrence during maintenance therapy is common and usually treated with an escalation of the glucocorticoids dose [ 15 ]. In this study, the majority of the cases needed a long-term treatment of glucocorticoids and only 4 cases tapered off glucocorticoids. Moreover, half of the cases also chosen used immunosuppressants in combination with glucocorticoids in this study. Immunosuppressants including HCQ, AZA, cyclophosphamide (CTX), MTX and so on were considered to be able to prevent recurrence and reduce the dose of glucocorticoids [ 2 , 15 ]. Whereas, the choice of immunosuppressants remained inconclusive. In overall, DAH in children was considered as a disease, which was characterized by a chronic and recurrent clinical course, as it usually needed ongoing treatment years after onset of disease [ 2 ]. In terms of cases with idiopathic DAH/IPH, they were also characterized by a chronic and recurrent clinical course [ 15 ]. Whereas, there is a lack data on the characteristics of the clinical course in DAH with onset in infancy currently. In this study, we found that the majority of the cases of DAH with onset in infancy also presented a chronic and recurrent clinical course. It was noteworthy that 3 cases (14.30%) presented a transient clinical course in this study, which demonstrated that there was a certain degree of heterogeneity in the cases of DAH with onset in infancy. The overall survival of idiopathic DAH/IPH has improved over the past decades mainly due to application of glucocorticoids and other immunosuppressive medications. The five-year survival has increased to 67–84% at the end of the twentieth century [ 15 ]. Respiratory failure due to the acute bleeding, pulmonary infection or pulmonary fibrosis was the primary cause of death in DAH [ 2 , 15 ]. The overall improvement of supportive care was also considered a reason for the improvement of overall survival in DAH [ 15 ]. In this study, 6 cases (23.1%) developed respiratory failure during the course of the disease, in which 1 case (7.8%) died. In addition to improve survival, attention should also be paid to improve the quality of life in the DAH in children, as long-term data demonstrated persistent abnormal radiology and a limited improvement in lung function in the cases with DAH in children [ 2 ]. For the cases of DAH with onset in infancy, we also faced the same problem. In this study, pulmonary fibrosis was found in 1 case and decreased endurance activity was found in 4 cases respectively. Nevertheless, there were some limitations in this study. Firstly, the sample size in this study was small, which might result in the selection bias. Secondly, this was a retrospective clinical study, which might result in the recall bias. In the future, a multiple centers, large sample size and prospective clinical study should be performed. Conclusions DAH with onset in infancy usually presented a chronic and recurrent clinical course. After treatments, death was less common, whereas pulmonary fibrosis or decreased endurance activity might develop. Abbreviations DAH diffuse alveolar hemorrhage BALF bronchoalveolar lavage fluid Hb hemoglobin IPH idiopathic pulmonary hemosiderosis AZA azathioprine MTX methotrexate HCQ hydroxychloroquine CTX cyclophosphamide Thal thalidomide MMF mycophenolate Cost Action CA16125 European network for translational research in children’s and adult interstitial lung disease chILDEU CRC European Research Collaboration for Children’s Interstitial Lung Disease SAVI STING-associated vasculopathy with onset in infancy Declarations Ethical approval This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of the First Affiliated Hospital of Guangxi Medical University (2025-E0361). Informed consent was obtained from all subjects and/or their legal guardian(s) in case of minors (below 16 years of age). All the methods and procedures carried out in this study were in accordance with relevant guidelines and regulation. Consent for publication Not applicable. Availability of Data and Materials All data generated or analyzed during this study are included in this published article. Competing interests The authors have no conflicts of interest relevant to this article to disclose. Funding This study was supported by the National Natural Science Foundation of Guangxi (2025GXNSFAA069702), Guangxi Clinical Research Center for Pediatric disease (NO: AD22035219), the grant (principal investigator: Guangmin Nong) from the Fund of Clinical Climbing Program of the First Affiliated Hospital of Guangxi Medical University (YYZS2020014) and Key Laboratory of Children's Disease Research in Guangxi’s Colleges and Universities, Education Department of Guangxi Zhuang Autonomous Region. Author contributions Xiao Wu and Jing Liu took part in designing the study, analysis as well as the interpretation of the data and drafting the manuscript. Qing Wei and Yan Li conceptualized and designed the whole study, supervised and instructed data collection and analysis, critically reviewed and revised the manuscript. Xun Chen, Fuce Lu and Guangmin Nong provided the clinical data, took part in collecting the data and reviewed the manuscript. Chunyan Li reviewed the CT scan and provided the imaging data. All authors have read and approved the final manuscript. Acknowledgements This study would like to thank the participants who gave their time to contribute to this study. The authors also would like to acknowledge doctors in the departments of Pediatrics and Radiology in the First Affiliated Hospital of Guangxi Medical University. Clinical trial number : not applicable. References Lara AR, Schwarz MI. Diffuse alveolar hemorrhage. Chest. 2010;137(5):1164–71. https://doi.org/10.1378/chest.08-2084 . Ring AM, Schwerk N, Kiper N, et al. Diffuse alveolar haemorrhage in children: an international multicentre study. 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STING-Associated Vasculopathy with Onset in Infancy in Three Children with New Clinical Aspect and Unsatisfactory Therapeutic Responses to Tofacitinib. J Clin Immunol. 2020;40(1):114–22. https://doi.org/10.1007/s10875-019-00690-9 . Deng Z, Chong Z, Law CS, et al. A defect in COPI-mediated transport of STING causes immune dysregulation in COPA syndrome. J Exp Med. 2020;217(11):e20201045. https://doi.org/10.1084/jem.20201045 . Tang X, Shen Y, Zhou C, et al. Surfactant protein C dysfunction with new clinical insights for diffuse alveolar hemorrhage and autoimmunity. Pediatr Investig. 2019;3(4):201–6. https://doi.org/10.1002/ped4.12162 . Saha BK. Idiopathic pulmonary hemosiderosis: A state of the art review. Respir Med. 2020;176:106234. https://doi.org/10.1016/j.rmed.2020.106234 . Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 31 Jan, 2026 Reviewers agreed at journal 30 Jan, 2026 Reviewers invited by journal 30 Jan, 2026 Editor assigned by journal 27 Jan, 2026 Editor invited by journal 06 Jan, 2026 Submission checks completed at journal 05 Jan, 2026 First submitted to journal 05 Jan, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8497779","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":583401215,"identity":"7d4e303a-2568-4303-9235-fce72bfdce64","order_by":0,"name":"Xiao Wu","email":"","orcid":"","institution":"Guangxi Medical University","correspondingAuthor":false,"prefix":"","firstName":"Xiao","middleName":"","lastName":"Wu","suffix":""},{"id":583401216,"identity":"7d551990-78da-4d0b-817c-468dc8fcb9a9","order_by":1,"name":"Jing Liu","email":"","orcid":"","institution":"Guangxi Medical University","correspondingAuthor":false,"prefix":"","firstName":"Jing","middleName":"","lastName":"Liu","suffix":""},{"id":583401217,"identity":"c881c7eb-a566-497d-a02f-ddc45f337ef9","order_by":2,"name":"Fuce Lu","email":"","orcid":"","institution":"Guangxi Medical University","correspondingAuthor":false,"prefix":"","firstName":"Fuce","middleName":"","lastName":"Lu","suffix":""},{"id":583401218,"identity":"c153fd8f-cdee-44f0-b865-8b62e0831901","order_by":3,"name":"Xun Chen","email":"","orcid":"","institution":"Guangxi Medical University","correspondingAuthor":false,"prefix":"","firstName":"Xun","middleName":"","lastName":"Chen","suffix":""},{"id":583401219,"identity":"cf4a8ef4-9e86-4066-b0cf-98b38a097b2e","order_by":4,"name":"Guangmin Nong","email":"","orcid":"","institution":"Guangxi Medical University","correspondingAuthor":false,"prefix":"","firstName":"Guangmin","middleName":"","lastName":"Nong","suffix":""},{"id":583401220,"identity":"59d57ce1-3ab4-4e87-b37d-259a5a52d9e1","order_by":5,"name":"Chunyan Li","email":"","orcid":"","institution":"Guangxi Medical University","correspondingAuthor":false,"prefix":"","firstName":"Chunyan","middleName":"","lastName":"Li","suffix":""},{"id":583401221,"identity":"7bf07f28-818a-40ef-9831-17ebd106b911","order_by":6,"name":"Yan Li","email":"","orcid":"","institution":"Guangxi Medical University","correspondingAuthor":false,"prefix":"","firstName":"Yan","middleName":"","lastName":"Li","suffix":""},{"id":583401222,"identity":"45c13efe-ca1b-4150-81ef-aebee0a0e537","order_by":7,"name":"Qing Wei","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA7ElEQVRIiWNgGAWjYFACxgaGBAYGHjb+5oMPEiok5PiJ1SLHL3Es2eDDGQtjyQYi7QKqzDGTnNlWkbiBkBaD482NNx7uqE3ccOCMmTTvPAnGDQzMDx/dwKflzMFmi8QzxxM3HG4rtubdJsFszsBmbJyDR4vZjcQ2icS2Y0BbDm+8DdTCZtnAwyaNV8v9hzAtCQbSvHMkeAwOENJygxGkpQbo/RQjyZkNEhIEtdifSQT6pe0ANJCPSRhINhPwi2T78Yc3f7bVQaOypq6+n7354WN8WkBAgoHhMBKXmYByqJY6IpSNglEwCkbBiAUA5/5U0DDit4cAAAAASUVORK5CYII=","orcid":"","institution":"Guangxi Medical University","correspondingAuthor":true,"prefix":"","firstName":"Qing","middleName":"","lastName":"Wei","suffix":""}],"badges":[],"createdAt":"2026-01-02 03:23:15","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8497779/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8497779/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":101789567,"identity":"aaf71dbb-e763-4944-9d33-11302f5d29d5","added_by":"auto","created_at":"2026-02-03 15:57:58","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":55920,"visible":true,"origin":"","legend":"\u003cp\u003eThe study flow diagram\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-8497779/v1/7a159362f084d98117e10c1a.jpeg"},{"id":101789568,"identity":"1b879d24-3219-403c-8118-e3431e2655e2","added_by":"auto","created_at":"2026-02-03 15:57:58","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":416579,"visible":true,"origin":"","legend":"\u003cp\u003eChest CT findings in the case with pulmonary fibrosis A: revealed no sign of pulmonary fibrosis; B: revealed interlobular septal thickening (green arrow) demonstrating pulmonary fibrosis in the same case to A\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-8497779/v1/8d6c1e70eecdbfc35d4a7cd5.png"},{"id":101880685,"identity":"d71e5ee3-e244-4800-b98f-e06e8729e6c5","added_by":"auto","created_at":"2026-02-04 15:05:11","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1579727,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8497779/v1/bdd32e8a-d40f-4259-bb2f-15580c00ae8d.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Diffuse alveolar hemorrhage with onset in infancy: a retrospective single-center study","fulltext":[{"header":"Background","content":"\u003cp\u003eDiffuse alveolar hemorrhage (DAH) is a relatively rare and severe life-threatening clinical syndrome in children [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. The majority of the cases having reported in the literature had onset beyond infancy [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Whereas, the cases with onset in infancy have been rarely reported. Until now, only about 20 cases have been reported in the literature [\u003cspan additionalcitationids=\"CR3 CR4 CR5 CR6 CR7\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. In the children with onset beyond infancy, DAH has been gradually well recognized. It was found to be caused by a wide variety of disorders and usually presented a chronic course with high mortality [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Whereas, it has not been recognized well in DAH with onset in infancy due to the rarity of the disease. In view of this, this present study is intended to explore the clinical features, treatments and outcomes of DAH with onset in infancy with the aim of extending clinician\u0026rsquo;s awareness and improving the diagnostic and therapeutic accuracy for this disease.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eSubjects\u003c/h2\u003e \u003cp\u003eIn this study, we screened the cases of DAH with onset in infancy from our pediatric DAH database between January 2012 and April 2025. (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e) The cases caused by the definite non-immune disorders such as congenital heart diseases, coagulation disorders, pulmonary infections, acute respiratory distress syndrome, inhalation injury were excluded. All the subjects agreed to participate this study.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eDiagnostic criteria for DAH\u003c/h3\u003e\n\u003cp\u003e \u003cstrong\u003eDAH was diagnosed when the subjects fulfilled all the following conditions\u003c/strong\u003e \u003cp\u003e⑴ presence of respiratory symptoms (dyspnea, hemoptysis or cough) or iron deficiency anemia; ⑵ diffuse pulmonary infiltrates (ground-glass opacities or consolidations) on the chest CT; ⑶ presence of hemosiderin laden macrophages in the bronchoalveolar lavage fluid (BALF) or lung tissue specimen [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e].\u003c/p\u003e \u003c/p\u003e\n\u003ch3\u003eDiagnostic criteria for anemia\u003c/h3\u003e\n\u003cp\u003eThe diagnostic criteria for anemia was defined as hemoglobin (Hb) level less than 120g/L in children greater or equal to 6 year-old, less than 110g/L in children greater or equal to 6 months and less than 6 year-old, less than 100g/L in children greater or equal to 4 months and less than 6 months, less than 90g/L in children greater or equal to 1 month and less than 4 months [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e\n\u003ch3\u003eDefinition for clinical course\u003c/h3\u003e\n\u003cp\u003eA chronic and recurrent clinical course was referred as disease duration of more than 6 months. A transient clinical course was referred as disease duration of less or equal to 6 months and absence of recurrence for more than 2 years.\u003c/p\u003e\n\u003ch3\u003eMethods\u003c/h3\u003e\n\u003cp\u003eA retrospective, observational study was conducted. Clinical data were collected by reviewing the medical records including the age of onset, the age of diagnosis, gender, etiologies, clinical features, treatment strategies and outcomes.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eStatistical analysis was performed using SPSS 25.0 soft. Measurement data were expressed as medians (25th-75th percentile). Counting data were expressed as count (percentage).\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eGeneral information\u003c/h2\u003e \u003cp\u003eA total of 285 pediatric cases of DAH were included, in which 26 cases (9.1%) presented with onset in infancy. (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eOf the cases with onset in infancy, there were 9 male and 17 female. All the cases were considered as idiopathic without any identifiable etiologies. One case had performed the whole-exome sequencing to further screen the variant genes associated with DAH, but revealed a negative result. The median age at onset were 8.0 (4.8, 10.3) months. The median age at diagnosis were 11.0 (6.8, 21.8) months. The median duration from disease onset to diagnosis were 2.5 (1.0, 12.0) months. (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eClinical data of diffuse alveolar hemorrhage with onset in infancy\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"18\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c13\" colnum=\"13\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c14\" colnum=\"14\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c15\" colnum=\"15\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c16\" colnum=\"16\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c17\" colnum=\"17\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c18\" colnum=\"18\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo.\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAge at onset\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAge at diagnosis\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eClinical manifestations at onset\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eLowest Hb level during the course of the disease\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eRF\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eECHO\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eANA\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003eAnti-GBM\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c11\"\u003e \u003cp\u003eANCA\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c12\"\u003e \u003cp\u003eComplements\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c13\"\u003e \u003cp\u003eDuration from the last chest CT to the disease onset\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c14\"\u003e \u003cp\u003eDuration from disease onset to the last follow-up\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c15\"\u003e \u003cp\u003eGlucocorticoids\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c16\"\u003e \u003cp\u003eImmunosuppressants\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c17\"\u003e \u003cp\u003eClinical course\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c18\"\u003e \u003cp\u003eOutcomes\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAnemia, cough, dyspnea\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e44.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eC\u003csub\u003e4\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c13\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003eY\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003eAZA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e \u003cp\u003eC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c18\"\u003e \u003cp\u003eS\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAnemia, dyspnea\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e42.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1:100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c13\"\u003e \u003cp\u003e39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003eHCQ, Thal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e \u003cp\u003eC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c18\"\u003e \u003cp\u003eS\u003csup\u003ed\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eHemoptysis, anemia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e56.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eND\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c13\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003eND\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e \u003cp\u003eC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c18\"\u003e \u003cp\u003eS\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eHemoptysis, anemia, cough\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e75.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c13\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003eMTX\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e \u003cp\u003eC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c18\"\u003e \u003cp\u003eS\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eHemoptysis, anemia, cough\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e92.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eND\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eND\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eND\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c13\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003eND\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003eND\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e \u003cp\u003eT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c18\"\u003e \u003cp\u003eS\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCough, dyspnea\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e115.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eY\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eND\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eND\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eND\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c13\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e \u003cp\u003eT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c18\"\u003e \u003cp\u003eS\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAnemia, cough, dyspnea\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e68.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eY\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1:100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eND\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c13\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003eND\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e \u003cp\u003eT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c18\"\u003e \u003cp\u003eS\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eHemoptysis, anemia, cough\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e25.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eND\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eND\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c13\"\u003e \u003cp\u003e71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003eAZA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e \u003cp\u003eC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c18\"\u003e \u003cp\u003eS\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAnemia, dyspnea\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e54.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eY\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eC\u003csub\u003e3/4\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c13\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003eND\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e \u003cp\u003eC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c18\"\u003e \u003cp\u003eD\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAnemia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e44.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1:100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eND\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c13\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003eMTX, HCQ\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e \u003cp\u003eC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c18\"\u003e \u003cp\u003eS\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eHemoptysis, anemia, cough\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e101.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1:100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eND\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c13\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003eND\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003eND\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003eND\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e \u003cp\u003eND\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c18\"\u003e \u003cp\u003eND\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAnemia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e45.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c13\"\u003e \u003cp\u003e64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003eHCQ, MTX\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e \u003cp\u003eC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c18\"\u003e \u003cp\u003eS\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eHaematemesis, anemia, cough\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e99.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c13\"\u003e \u003cp\u003e94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003eAZA, MMF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e \u003cp\u003eC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c18\"\u003e \u003cp\u003eS\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAnemia, dyspnea\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e23.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eC\u003csub\u003e4\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c13\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003eND\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003eMTX\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e \u003cp\u003eC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c18\"\u003e \u003cp\u003eND\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eHemoptysis, anemia,\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e63.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e1:10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c13\"\u003e \u003cp\u003e106\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e108\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003eY\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003eMTX, HCQ, Thal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e \u003cp\u003eC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c18\"\u003e \u003cp\u003eS\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eHemoptysis, anemia, cough\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e66.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eND\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eND\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c13\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003eND\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003eND\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e \u003cp\u003eC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c18\"\u003e \u003cp\u003eND\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAnemia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e44.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1:100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c13\"\u003e \u003cp\u003e89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e110\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003eY\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003eMTX, AZA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e \u003cp\u003eC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c18\"\u003e \u003cp\u003eS\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e18\u003csup\u003ee\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCough, dyspnea\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e112.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eY\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1:100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eND\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c13\"\u003e \u003cp\u003e117\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e120\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003eND\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e \u003cp\u003eC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c18\"\u003e \u003cp\u003eS\u003csup\u003ed\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAnemia, cough, dyspnea\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e99.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eND\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eND\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eND\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c13\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003eND\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003eND\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e \u003cp\u003eC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c18\"\u003e \u003cp\u003eND\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAnemia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e20.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eC\u003csub\u003e4\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c13\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003eND\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003eND\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e \u003cp\u003eND\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c18\"\u003e \u003cp\u003eND\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAnemia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e33.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c13\"\u003e \u003cp\u003e125\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e128\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003eY\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003eMTX, HCQ\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e \u003cp\u003eC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c18\"\u003e \u003cp\u003eS\u003csup\u003ed\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eHaematemesis, melena, anemia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e70.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eND\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eND\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eND\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eC\u003csub\u003e3/4\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c13\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003eND\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003eND\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e \u003cp\u003eND\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c18\"\u003e \u003cp\u003eND\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eHemoptysis, anemia, cough\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e48.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c13\"\u003e \u003cp\u003e37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e131\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003eAZA, MTX\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e \u003cp\u003eC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c18\"\u003e \u003cp\u003eS\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAnemia, cough, dyspnea\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e81.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eND\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c13\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e135\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003eND\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e \u003cp\u003eND\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c18\"\u003e \u003cp\u003eS\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAnemia,\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e44.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eND\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c13\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e153\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003eND\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e \u003cp\u003eND\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c18\"\u003e \u003cp\u003eS\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eHemoptysis, anemia, cough\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e53.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eC\u003csub\u003e4\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c13\"\u003e \u003cp\u003e105\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e175\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003eMTX, AZA, HCQ\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e \u003cp\u003eC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c18\"\u003e \u003cp\u003eS\u003csup\u003ed\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"18\"\u003e\u003cem\u003eM\u003c/em\u003e, male; \u003cem\u003eF\u003c/em\u003e, female; \u003cem\u003eRF\u003c/em\u003e, respiratory failure; \u003cem\u003eECHO\u003c/em\u003e, echocardiography; \u003cem\u003eS\u003c/em\u003e, survival; \u003cem\u003eD\u003c/em\u003e, death; \u003cem\u003eC\u003c/em\u003e, a chronic and recurrent clinical course; \u003cem\u003eT\u003c/em\u003e, a transient clinical course; \u003cem\u003eND\u003c/em\u003e, not done; \u003cem\u003eN\u003c/em\u003e, negative; \u003cem\u003eY\u003c/em\u003e, done; \u003cem\u003eHb\u003c/em\u003e, hemoglobin; \u003cem\u003eAZA\u003c/em\u003e, azathioprine; \u003cem\u003eMTX\u003c/em\u003e, methotrexate; \u003cem\u003eHCQ\u003c/em\u003e, hydroxychloroquine; \u003cem\u003eThal\u003c/em\u003e, thalidomide; \u003cem\u003eMMF\u003c/em\u003e, mycophenolate\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"18\"\u003ea: These cases needed invasive mechanical ventilation.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"18\"\u003eb: ECHO revealed pulmonary arterial hypertension in these cases.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"18\"\u003ec: These cases tapered off glucocorticoids successfully according to medical advice.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"18\"\u003ed: These cases had decreased endurance activity.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"18\"\u003ee: This case developed pulmonary fibrosis. He performed the whole-exome sequencing, but revealed a negative result.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eClinical manifestations\u003c/h2\u003e \u003cp\u003eAt onset of the disease, the most common clinical manifestation was anemia, which was found in 24 cases (92.3%). The following clinical manifestations included cough in 14 cases (53.8%), hemoptysis in 9 cases (34.6%), dyspnea in 9 cases (34.6%), haematemesis in 2 cases (7.7%) and melena in 1 casese (3.8%). (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eDuring the course of the disease, the median levels of the lowest Hb were 55.0 (44.0, 83.8) g/L. Respiratory failure was found in 6 cases (23.1%), in which 2 cases (7.8%) needed invasive mechanical ventilation. Total 18 cases had performed echocardiography, in which pulmonary arterial hypertension was found in 2 cases (11.1%). Two case (7.7%) had renal involvement presenting as hematuia and/or proteinuria, but without impaired kidney function. (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eAutoantibodies and complements detection\u003c/h2\u003e \u003cp\u003eDuring the course of the disease, 23 cases (88.5%) had performed autoantibodies including ANA, ANCA and anti-GBM detection, in which 9 cases (39.1%) revealed positive findings. Of these, 20 cases had performed ANA detection, in which 6 cases (30.0%) revealed a positive result. Twenty three cases had performed anti-GBM detection, in which 4 cases (17.4%) revealed a positive result. Nineteen cases had performed ANCA detection, in which 1 case (5.3%) revealed a positive result. Nineteen cases (73.1%) had performed complements detection, in which 6 cases (31.6%) revealed a decline of complement levels (C3 and/or C4). (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eTreatment strategies\u003c/h2\u003e \u003cp\u003eTwenty three cases (88.5%) had received glucocorticoids treatment and 13 cases (50.0%) had received immunosuppressants treatment. The immunosuppressants having administrated in these cases included methotrexate (MTX) in 9 cases, hydroxychloroquine (HCQ) in 6 cases, azathiopine (AZA) in 6 cases, thalidomide (Thal) in 2 cases and mycophenolate (MMF) in 1 case. Of note, 4 cases (15.4%) tapered off glucocorticoids successfully according to medical advice, but still needed immunosuppressants treatment. The duration of administration of glucocorticoids in these 4 cases were 40.0, 78.0, 89.0 and 106.0 months respectively. (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eDisease course and outcome\u003c/h2\u003e \u003cp\u003eThe clinical course couldn\u0026rsquo;t been classified due to lack of enough information in 5 cases. Of the rest 21 cases, 18 cases (85.7%) presented a chronic and recurrent clinical course and 3 cases (14.3%) presented a transient clinical course. (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eAll the cases had performed chest CT examination. The median duration from the last chest CT to the disease onset were 33.0 (9.0, 75.5) months. Follow-up chest CT revealed pulmonary fibrosis in 1 cases (3.8%). (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e) By the end of April 2025, there were 20 cases with available follow-up, in which 1 case (5.0%) died and 19 cases (95.0%) survived. Of these 19 survived cases, the median duration from disease onset to the last follow-up were 93.0 (58.8, 126.0) months and 4 cases (21.1%) had decreased endurance activity. (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eDAH is a relatively rare disease in children and can be caused by a wide variety of etiologies. Onset of DAH may occur at all ages, whereas it is relatively rare in infancy. Until now, there has been not many systematic researches on DAH in children. The first article involving a multi-center study of DAH in children was reported in 2023, which was from the European network for translational research in children\u0026rsquo;s and adult interstitial lung disease (Cost Action CA16125) and chILDEU CRC (the European Research Collaboration for Children\u0026rsquo;s Interstitial Lung Disease) [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. In this study, total 124 cases were included, whereas the cases with onset in infancy were less than 5 cases and the median age at onset was 5 year-old [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. According to statistics, the cases of DAH with onset in infancy having reported in the literature were only about 20 cases [\u003cspan additionalcitationids=\"CR3 CR4 CR5 CR6 CR7\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. In view of this, we conducted this study. In this study, total 26 cases of DAH with onset in infancy were included. To our knowledge, this present study comprises the largest sample size currently analyzed for DAH with onset in infancy.\u003c/p\u003e \u003cp\u003eDue to the rarity of the disease and a relatively low clinical awareness, there is usually a delay in diagnosis of DAH in clinic. According to the literature, the median diagnostic delay in DAH in children were 2.0 months [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. To infants, it seems to be a greater challenge due to the poor expressive ability. In this study, the median diagnostic delay in DAH with onset in infancy were 2.5 months, which was similar to the findings in the cases with DAH in children as mentioned above. This is likely due to the raised clinical awareness of this disease in our clinical center.\u003c/p\u003e \u003cp\u003eThe classical triad of clinical features of DAH includes hemoptysis, diffuse parenchymal infiltrates on chest imaging and iron deficiency anemia [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Whereas, the classical triad of clinical features of DAH is uncommon. This might be partly due to the low incidence of hemoptysis in cases with DAH in children [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. In this study, hemoptysis was found to be more uncommon in the DAH with onset in infancy, in which hemoptysis was only found in about 1/3 of the cases. In fact, the most frequent clinical presentations of DAH in children was anemia [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Also, our results were consistent with this finding. Therefore, we should pay attention to DAH screening in the cases with anemia.\u003c/p\u003e \u003cp\u003eDAH can be caused by a wide variety of etiologies including the immune disorders and non-immune disorders. In this study, all the cases were considered as idiopathic without any identifiable etiologies. It was noteworthy that 2 cases also had renal involvement, which demonstrated the possibility of underlying systemic diseases. In recent years, DAH has been found in the cases with gene variants diseases such as \u003cem\u003eCOPA\u003c/em\u003e syndrome, \u003cem\u003eSTING\u003c/em\u003e-associated vasculopathy with onset in infancy (SAVI), \u003cem\u003eSFTPC\u003c/em\u003e related diseases [\u003cspan additionalcitationids=\"CR13\" citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e], which might present onset of DAH in infancy. In this study, 1 case had performed the whole-exome sequencing to further screen the variant genes associated with DAH, but revealed a negative result. In the previous literature, idiopathic DAH was usually referred as idiopathic pulmonary hemosiderosis (IPH). Hereby, we collectively termed the cases as idiopathic DAH/IPH. Idiopathic DAH/IPH has been considered as non-immune mediated in the past [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Whereas, there was considerable evidence to support the immunologic association of the disease, as idiopathic DAH/IPH usually presented a good response to immunosuppressive therapy and positive autoantibodies were present in about 25% of the cases during the course of the disease [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. In this study, our results were consistent with these findings. Besides that, about 1/3 of the cases in our study revealed decline of complements either, which also supported the immunologic association of the disease.\u003c/p\u003e \u003cp\u003eAs mentioned above, idiopathic DAH/IPH is considered and treated as an immune-mediated disease. Currently, glucocorticoids alone or in combination with other immunosuppressive regimens are often employed for the treatment of idiopathic DAH/IPH [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. In this study, the majority of the cases chose use of glucocorticoids and showed a good response to glucocorticoids therapy in a short-term. The optimal duration of therapy with glucocorticoids is unknown. Recommendation in the literature suggested that glucocorticoids should be slowly tapered off until discontinuation, if the cases remains well-controlled for 12\u0026ndash;18 months [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Unfortunately, recurrence during maintenance therapy is common and usually treated with an escalation of the glucocorticoids dose [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. In this study, the majority of the cases needed a long-term treatment of glucocorticoids and only 4 cases tapered off glucocorticoids. Moreover, half of the cases also chosen used immunosuppressants in combination with glucocorticoids in this study. Immunosuppressants including HCQ, AZA, cyclophosphamide (CTX), MTX and so on were considered to be able to prevent recurrence and reduce the dose of glucocorticoids [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Whereas, the choice of immunosuppressants remained inconclusive.\u003c/p\u003e \u003cp\u003eIn overall, DAH in children was considered as a disease, which was characterized by a chronic and recurrent clinical course, as it usually needed ongoing treatment years after onset of disease [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. In terms of cases with idiopathic DAH/IPH, they were also characterized by a chronic and recurrent clinical course [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Whereas, there is a lack data on the characteristics of the clinical course in DAH with onset in infancy currently. In this study, we found that the majority of the cases of DAH with onset in infancy also presented a chronic and recurrent clinical course. It was noteworthy that 3 cases (14.30%) presented a transient clinical course in this study, which demonstrated that there was a certain degree of heterogeneity in the cases of DAH with onset in infancy.\u003c/p\u003e \u003cp\u003eThe overall survival of idiopathic DAH/IPH has improved over the past decades mainly due to application of glucocorticoids and other immunosuppressive medications. The five-year survival has increased to 67\u0026ndash;84% at the end of the twentieth century [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Respiratory failure due to the acute bleeding, pulmonary infection or pulmonary fibrosis was the primary cause of death in DAH [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. The overall improvement of supportive care was also considered a reason for the improvement of overall survival in DAH [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. In this study, 6 cases (23.1%) developed respiratory failure during the course of the disease, in which 1 case (7.8%) died. In addition to improve survival, attention should also be paid to improve the quality of life in the DAH in children, as long-term data demonstrated persistent abnormal radiology and a limited improvement in lung function in the cases with DAH in children [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. For the cases of DAH with onset in infancy, we also faced the same problem. In this study, pulmonary fibrosis was found in 1 case and decreased endurance activity was found in 4 cases respectively.\u003c/p\u003e \u003cp\u003eNevertheless, there were some limitations in this study. Firstly, the sample size in this study was small, which might result in the selection bias. Secondly, this was a retrospective clinical study, which might result in the recall bias. In the future, a multiple centers, large sample size and prospective clinical study should be performed.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eDAH with onset in infancy usually presented a chronic and recurrent clinical course. After treatments, death was less common, whereas pulmonary fibrosis or decreased endurance activity might develop.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eDAH\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ediffuse alveolar hemorrhage\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eBALF\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ebronchoalveolar lavage fluid\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eHb\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ehemoglobin\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eIPH\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eidiopathic pulmonary hemosiderosis\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eAZA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eazathioprine\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eMTX\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003emethotrexate\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eHCQ\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ehydroxychloroquine\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCTX\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ecyclophosphamide\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eThal\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ethalidomide\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eMMF\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003emycophenolate\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCost Action CA16125\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eEuropean network for translational research in children\u0026rsquo;s and adult interstitial lung disease\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003echILDEU CRC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eEuropean Research Collaboration for Children\u0026rsquo;s Interstitial Lung Disease\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSAVI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eSTING-associated vasculopathy with onset in infancy\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical approval\u0026nbsp;\u003c/strong\u003eThis study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of the First Affiliated Hospital of Guangxi Medical University (2025-E0361). Informed consent was obtained from all subjects and/or their legal guardian(s) in case of minors (below 16 years of age). All the methods and procedures carried out in this study were in accordance with relevant guidelines and regulation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of Data and Materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data generated or analyzed during this study are included in this published article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors have no conflicts of interest relevant to this article to disclose.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was supported by the National Natural Science Foundation of Guangxi (2025GXNSFAA069702), Guangxi Clinical Research Center for Pediatric disease (NO: AD22035219), the grant (principal investigator: Guangmin Nong) from the Fund of Clinical Climbing Program of the First Affiliated Hospital of Guangxi Medical University (YYZS2020014) and Key Laboratory of Children\u0026apos;s Disease Research in Guangxi\u0026rsquo;s Colleges and Universities, Education Department of Guangxi Zhuang Autonomous Region.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eXiao Wu and Jing Liu took part in designing the study, analysis as well as the interpretation of the data and drafting the manuscript. Qing Wei and Yan Li conceptualized and designed the whole study, supervised and instructed data collection and analysis, critically reviewed and revised the manuscript. Xun Chen, Fuce Lu and Guangmin Nong provided the clinical data, took part in collecting the data\u0026nbsp;and\u0026nbsp;reviewed the manuscript. Chunyan Li reviewed the CT scan and provided the imaging data. All authors have read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study would like to thank the participants who gave their time to contribute to this study. The authors also would like to acknowledge doctors in the departments of Pediatrics and Radiology in the First Affiliated Hospital of Guangxi Medical University.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number\u003c/strong\u003e: not applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eLara AR, Schwarz MI. Diffuse alveolar hemorrhage. Chest. 2010;137(5):1164\u0026ndash;71. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1378/chest.08-2084\u003c/span\u003e\u003cspan address=\"10.1378/chest.08-2084\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRing AM, Schwerk N, Kiper N, et al. Diffuse alveolar haemorrhage in children: an international multicentre study. 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Pediatrics. 2015;135(1):e216\u0026ndash;220. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1542/peds.2014-1782\u003c/span\u003e\u003cspan address=\"10.1542/peds.2014-1782\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGallagher PG. Anemia in the pediatric patient. Blood. 2022;140(6):571\u0026ndash;93. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1182/blood.2020006479\u003c/span\u003e\u003cspan address=\"10.1182/blood.2020006479\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFletcher A, Forbes A, Svenson N, et al. A British Society for Haematology Good Practice Paper. Guideline for the laboratory diagnosis of iron deficiency in adults (excluding pregnancy) and children. 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STING-Associated Vasculopathy with Onset in Infancy in Three Children with New Clinical Aspect and Unsatisfactory Therapeutic Responses to Tofacitinib. J Clin Immunol. 2020;40(1):114\u0026ndash;22. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s10875-019-00690-9\u003c/span\u003e\u003cspan address=\"10.1007/s10875-019-00690-9\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDeng Z, Chong Z, Law CS, et al. A defect in COPI-mediated transport of STING causes immune dysregulation in COPA syndrome. 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Respir Med. 2020;176:106234. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.rmed.2020.106234\u003c/span\u003e\u003cspan address=\"10.1016/j.rmed.2020.106234\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-pediatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bped","sideBox":"Learn more about [BMC Pediatrics](http://bmcpediatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bped/default.aspx","title":"BMC Pediatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"diffuse alveolar hemorrhage, infancy, anemia, glucocorticoid, clinical course","lastPublishedDoi":"10.21203/rs.3.rs-8497779/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8497779/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e To explore the clinical features, treatments and outcomes of diffuse alveolar hemorrhage (DAH) with onset in infancy with the aim of extending clinician’s awareness and improving the diagnostic and therapeutic accuracy for the disease.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods \u003c/strong\u003eThe cases of DAH with onset in infancy, who had been hospitalized in the Department of Pediatrics at the First Affiliated Hospital of Guangxi Medical University from January 2012 and April 2025 were included. A retrospective study was conducted.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults \u003c/strong\u003e1. A total of 285 pediatric cases of DAH were included, in which 26 cases (9.1%) presented with onset in infancy. 2.Of the cases with onset in infancy, the median age at onset were 8.0 (4.8, 10.3) months. The median age at diagnosis were 11.0 (6.8, 21.8) months. The median duration from disease onset to diagnosis were 2.5 (1.0, 12.0) months. 3. At onset of the disease, the most common clinical manifestation was anemia which was found in 24 cases (92.3%) and the following clinical manifestations included cough in 14 cases (53.8%), hemoptysis in 9 cases (34.6%), dyspnea in 9 cases (34.6%), haematemesis in 2 cases (7.7%) and melena in 1 case (3.8%). Respiratory failure was found in 6 cases (23.12%). 4. Twenty three cases (88.5%) had received glucocorticoids treatment and 13 cases (50.0%) had received immunosuppressants treatment. 5. Assess of the clinical course were available in 21 cases, in which 18 cases (85.7%) presented a chronic and recurrent clinical course and 3 cases (14.3%) presented a transient clinical course. 5. By the end of April 2025, there were 20 cases with available follow-up, in which 1 case (5.0%) died and 19 cases (95.0%) survived. Of these 19 survived cases, 4 cases (21.1%) had decreased endurance activity. Follow-up chest CT revealed pulmonary fibrosis in 1 cases (3.8%).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions \u003c/strong\u003eDAH with onset in infancy was uncommon. It usually presented a chronic and recurrent clinical course. After treatments, death was less common, whereas pulmonary fibrosis or decreased endurance activity might develop.\u003c/p\u003e","manuscriptTitle":"Diffuse alveolar hemorrhage with onset in infancy: a retrospective single-center study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-03 15:57:53","doi":"10.21203/rs.3.rs-8497779/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-01-31T06:53:13+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"141191622794602960836734941340851672041","date":"2026-01-30T14:32:22+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-01-30T13:38:08+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-01-27T09:30:17+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-01-06T12:56:04+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-01-06T03:07:16+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Pediatrics","date":"2026-01-06T02:59:55+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-pediatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bped","sideBox":"Learn more about [BMC Pediatrics](http://bmcpediatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bped/default.aspx","title":"BMC Pediatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"5b9e3bfd-9b40-4d7d-9c1a-4b03c25a0d32","owner":[],"postedDate":"February 3rd, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-02-03T15:57:53+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-03 15:57:53","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8497779","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8497779","identity":"rs-8497779","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}