Diffuse alveolar hemorrhage: Difference between revisions
 
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===Background===
==Background==
* Diffuse Alveolar Hemorrhage (DAH) is a life-threatening condition. 
*Diffuse Alveolar Hemorrhage (DAH) is a life-threatening condition
* It is a subset of Pulmonary hemorrhage involving the microcirculation involving alveolar microvasculature.
*It is a subset of Pulmonary hemorrhage involving the microcirculation involving alveolar microvasculature
* Most commonly the result of systemic vasculitis. <ref>Park M. Diffuse Alveolar Hemorrhage. Tuberc Resp Dis (Seoul) 2013. 74(4):151-162</ref>
*Most commonly the result of systemic vasculitis <ref>Park M. Diffuse Alveolar Hemorrhage. Tuberc Resp Dis (Seoul) 2013. 74(4):151-162</ref>


===Clinical Features===
==Clinical Features==
* [[Hemoptysis]] ( may be initially absent in up 33% of DAH presentations <ref>Lara A, Schwarz M. Diffuse Alveolar Hemorrhage. Chest 2010. 137(5):1164-1171</ref>
*[[Hemoptysis]] (may be initially absent in up 33% of DAH presentations) <ref>Lara A, Schwarz M. Diffuse Alveolar Hemorrhage. Chest 2010. 137(5):1164-1171</ref>
* [[Anemia]]
*[[Anemia]]
* Diffuse lung infiltrates
*Diffuse lung infiltrates
* Acute hypoxemic respiratory failure
*Acute hypoxemic [[respiratory failure]]


===Differential Diagnosis===
==Differential Diagnosis==
*Idiopathic small vessel vasculitis
**[[Granulomatosis with polyangiitis]] (Wegener's)
**[[Churg-Strauss syndrome]]
**Microscopic polyangitis
*Primary immune complex-mediated vasculitis
**[[Goodpasture syndrome]]
**[[Henoch-Schonlein purpura]]
*Secondary vasculitis
**[[Systemic lupus erythematosus]]
**[[Rheumatoid arthritis]]
**Mixed [[connective tissue disease]]
**[[Polymyositis]]/[[Dermatomyositis]]
*Acute [[lung transplant]] rejection
*Drug induced (ie. chemotherapy, [[amiodarone]], [[propylthiouracil]])
*[[ARDS]]
*Multilobar [[Pneumonia]]
*[[Coagulopathy]]
*Pulmonic veno-occlusive disease
*[[Mitral stenosis]]


Idiopathic small vessel vasculitis
==Evaluation==
* [[Wegener's granulomatosis]]
*Clinical suspicion with falling hematocrit
* Churg-Straus syndrome
*Radiographic imaging consistent with bilateral infiltration ([[CXR]], CT) - can be patchy, focal or diffuse
* Microscopic polyangitis
*Bronchoscopy with BAL showing sequentially increasing RBC counts


Primary immune complex-mediated vasculitis
==Management==
* Goodpasture's syndrome
*Airway stabilization if large volume hemoptysis or problems with oxygenation/ventilation (>8.0 ETT preferable)
* [[Henoch-Schonlein purpura]]
*IV [[corticosteroids]] - high dose [[Corticosteroids|Methylprednisolone]] Q6H<ref>Park M. Diffuse Alveolar Hemorrhage. Tuberc Resp Dis (Seoul) 2013. 74(4):151-162</ref>
*Bronchoscopy to obtain BAL and localize/address source of bleeding if localizable
*[[Hemoptysis|Management of Hemoptysis]]
**Correct any [[coagulopathy]]
**Consider nebulized [[TXA]] if massive<ref>Wand O, et al. Inhaled Tranexamic Acid for Hemoptysis Treatment: A Randomized Controlled Trial. Chest. DOI: https://doi.org/10.1016/j.chest.2018.09.026</ref>


Secondary vasculitis
==Disposition==
* [[Systemic lupus erythematosus]]
*Typically requires upper level of care
* [[Rheumatoid arthritis]]
* Mixed connective tissue disease
* [[Polymyositis]]/[[Dermatomyositis]]


Acute [[lung transplant]] rejection<br />
==See Also==
*[[Hemoptysis]]


Drug induced (ie. chemotherapy, [[amiodarone]], propylthiouracil)<br />
==External Links==
[http://lifeinthefastlane.com/ccc/diffuse-alveolar-haemorrhage/ Life in the Fast Lane: Diffuse Alveolar Hemorrhage]


[[ARDS]]<br />
==References==
<references/>


Multilobar [[Pneumonia]]<br />
[[Category:Pulmonary]]
 
[[Coagulopathy]]<br />
 
Pulmonic veno-occlusive disease <br />
 
[[Mitral stenosis]]
 
===Diagnosis===
# Clinical suspicion with falling hematocrit
# Radiographic imaging consistent with bilateral infiltration (CXR, CT) - can be patchy, focal or diffuse
# Bronchoscopy with BAL showing sequentially increasing RBC counts
 
===Management===
General principles
* Airway stabilization if large volume hemoptysis or problems with oxygenation/ventilation (>8.0 ETT preferable)
* IV corticosteroids - high dose [[Corticosteroids|Methylprednisolone]] Q6H<ref>Park M. Diffuse Alveolar Hemorrhage. Tuberc Resp Dis (Seoul) 2013. 74(4):151-162</ref>
* Bronchoscopy to obtain BAL and localize source of bleeding if localizable
* [[Hemoptysis|Management of Hemoptysis]]
 
===Disposition===

Latest revision as of 15:41, 5 August 2021

Background

  • Diffuse Alveolar Hemorrhage (DAH) is a life-threatening condition
  • It is a subset of Pulmonary hemorrhage involving the microcirculation involving alveolar microvasculature
  • Most commonly the result of systemic vasculitis [1]

Clinical Features

Differential Diagnosis

Evaluation

  • Clinical suspicion with falling hematocrit
  • Radiographic imaging consistent with bilateral infiltration (CXR, CT) - can be patchy, focal or diffuse
  • Bronchoscopy with BAL showing sequentially increasing RBC counts

Management

Disposition

  • Typically requires upper level of care

See Also

External Links

Life in the Fast Lane: Diffuse Alveolar Hemorrhage

References

  1. ↑ Park M. Diffuse Alveolar Hemorrhage. Tuberc Resp Dis (Seoul) 2013. 74(4):151-162
  2. ↑ Lara A, Schwarz M. Diffuse Alveolar Hemorrhage. Chest 2010. 137(5):1164-1171
  3. ↑ Park M. Diffuse Alveolar Hemorrhage. Tuberc Resp Dis (Seoul) 2013. 74(4):151-162
  4. ↑ Wand O, et al. Inhaled Tranexamic Acid for Hemoptysis Treatment: A Randomized Controlled Trial. Chest. DOI: https://doi.org/10.1016/j.chest.2018.09.026
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