# 出血（Hemorrhage）

- 器官 / 系统：肺 / 呼吸系统（lung / respiratory-system）
- NTP 数据编号：ntp-0098
- 规范 URL：https://www.labsmart.cn/ntp/lung-hemorrhage.html
- 中文图谱总页锚点：https://www.labsmart.cn/ntp-atlas.html#lung-hemorrhage
- 原始出处：https://ntp.niehs.nih.gov/atlas/nnl/respiratory-system/lung/Hemorrhage
- 授权：美国联邦政府作品，公有领域；引用请标注 NTP Nonneoplastic Lesion Atlas
- 适用说明：仅供科研使用，不用于临床诊断

## 一句话结论
出血（Hemorrhage）（Figure 1、Figure 2、Figure 3、Figure 4）的特征是气道内、肺血管周围和/或肺泡腔内有外渗的血细胞积聚。

## 病变描述（中文）
出血（Hemorrhage）（Figure 1、Figure 2、Figure 3、Figure 4）的特征是气道内、肺血管周围和/或肺泡腔内有外渗的血细胞积聚。当肺毒素引起广泛实质或内皮细胞损伤时，肺内可发生出血。在此类情况下，常同时存在坏死、炎症或纤维化（作为慢性后遗症）。小量出血可继发于心力衰竭，最常表现为含红细胞或含铁血黄素色素的肺泡巨噬细胞聚集（“心力衰竭细胞”）。无论出血原因如何，在外渗的红细胞之间常可见含红细胞（红细胞吞噬现象）和含铁血黄素色素的肺泡巨噬细胞。与二氧化碳安乐死相关的出血常可见于胸膜下。此外，使用70%二氧化碳进行麻醉可诱发大鼠肺泡内小面积出血，这通常见于对照动物以及受试动物，且与出血相关的不会有含铁血黄素的巨噬细胞。

## 诊断与分级建议（NTP 共识，中文）
当出血由肺毒物直接引起时，应诊断为肺－出血并给出严重程度分级。当出血是其他病变（如肿瘤、坏死或炎症）的特征时，不应诊断出血，但应在病理学叙述中描述。然而，如果出血是炎症性或慢性病变的显著组成部分，则可由病理学家酌情诊断。继发于二氧化碳暴露的出血无需诊断（病理学家应运用其判断来确定是否属于这种情况）。如果未诊断出血，但出血与研究相关（例如，如果它掩盖或混淆了其他诊断），则应在病理学叙述中提及。

## 英文原文 · Comment
Hemorrhage ( Figure 1 , Figure 2 , Figure 3 , and Figure 4 ) is characterized by accumulations of extravasated blood cells in airways, around pulmonary vessels, and/or in alveolar lumina. Hemorrhage may occur in the lung when there is extensive parenchymal or endothelial cell damage caused by pulmonary toxins. In such cases, necrosis, inflammation, or fibrosis (as a chronic sequela) often is present concurrently. Small hemorrhages can occur secondary to heart failure, which most commonly manifests as collections of alveolar macrophages containing erythrocytes or hemosiderin pigment ("heart failure cells"). Regardless of the cause of the hemorrhage, alveolar macrophages containing erythrocytes (erythrophagocytosis), and hemosiderin pigment are frequently seen amid extravasated erythrocytes. Hemorrhage is frequently observed subpleurally when related to euthanasia with carbon dioxide. In addition, the use of 70% carbon dioxide for anesthesia may induce small areas of hemorrhage in alveoli of rats, which will typically be seen in control as well as treated animals, and no hemosiderin-laden macrophages will be associated with the hemorrhage.

## 英文原文 · Recommendation
Lung - Hemorrhage should be diagnosed and given a severity grade when directly caused by a pulmonary toxicant. Hemorrhage should not be diagnosed when it is a feature of another lesion, such as neoplasia, necrosis, or inflammation, but should be described in the pathology narrative. If, however, the hemorrhage is a prominent component of an inflammatory or chronic lesion, it may be diagnosed at the discretion of the pathologist. Hemorrhage that is secondary to carbon dioxide exposure need not be diagnosed (the pathologist should use his/her judgment in determining if this is the case). If the hemorrhage is not diagnosed, it should be mentioned in the pathology narrative if it has relevance to the study (e.g., if it obscures or confounds other diagnoses).

## 配图
- https://www.labsmart.cn/ntp-atlas-images/ntp_0868.jpg
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