Diffuse alveolar hemorrhage
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
- Hemoptysis
- Anemia
- Diffuse lung infiltrates
- Acute respiratory failure
Differential Diagnosis
Idiopathic small vessel vasculitis
- Wegener's granulomatosis
- Churg-Straus syndrome
- Microscopic polyangitis
Primary immune complex-mediated vasculitis
- Goodpasture's 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
Coagulopathy
Pulmonic veno-occlusive disease
Mitral stenosis
Diagnosis
Management
General principles
- Airway stabilization if large volume hemoptysis or problems with oxygenation/ventilation (>8.0 ETT preferable)
- IV corticosteroids - high dose Methylprednisolone Q6H[2]
- Bronchoscopy to obtain BAL and localize source of bleeding if localizable
- Management of Hemoptysis