Diffuse alveolar hemorrhage: Difference between revisions
ClaireLewis (talk | contribs) No edit summary |
ClaireLewis (talk | contribs) No edit summary |
||
| Line 21: | Line 21: | ||
**[[Systemic lupus erythematosus]] | **[[Systemic lupus erythematosus]] | ||
**[[Rheumatoid arthritis]] | **[[Rheumatoid arthritis]] | ||
**Mixed connective tissue disease | **Mixed [[connective tissue disease]] | ||
**[[Polymyositis]]/[[Dermatomyositis]] | **[[Polymyositis]]/[[Dermatomyositis]] | ||
*Acute [[lung transplant]] rejection | *Acute [[lung transplant]] rejection | ||
| Line 39: | Line 39: | ||
*Airway stabilization if large volume hemoptysis or problems with oxygenation/ventilation (>8.0 ETT preferable) | *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> | *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 | *Bronchoscopy to obtain BAL and localize/address source of bleeding if localizable | ||
*[[Hemoptysis|Management of Hemoptysis]] | *[[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> | |||
==Disposition== | ==Disposition== | ||
Revision as of 15:29, 12 October 2019
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 ( may be initially absent in up 33% of DAH presentations [2]
- Anemia
- Diffuse lung infiltrates
- Acute hypoxemic respiratory failure
Differential Diagnosis
- Idiopathic small vessel vasculitis
- Granulomatosis with polyangiitis (Wegener's)
- Churg-Strauss syndrome
- Microscopic polyangitis
- Primary immune complex-mediated vasculitis
- Secondary vasculitis
- Acute lung transplant rejection
- Drug induced (ie. chemotherapy, amiodarone, propylthiouracil)
- ARDS
- Multilobar Pneumonia
- Coagulopathy
- Pulmonic veno-occlusive disease
- Mitral stenosis
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
- Airway stabilization if large volume hemoptysis or problems with oxygenation/ventilation (>8.0 ETT preferable)
- IV corticosteroids - high dose Methylprednisolone Q6H[3]
- Bronchoscopy to obtain BAL and localize/address source of bleeding if localizable
- Management of Hemoptysis
- Correct any coagulopathy
- Consider nebulized TXA if massive[4]
Disposition
- Typically requires upper level of care
See Also
External Links
Life in the Fast Lane: Diffuse Alveolar Hemorrhage
References
- ↑ Park M. Diffuse Alveolar Hemorrhage. Tuberc Resp Dis (Seoul) 2013. 74(4):151-162
- ↑ Lara A, Schwarz M. Diffuse Alveolar Hemorrhage. Chest 2010. 137(5):1164-1171
- ↑ Park M. Diffuse Alveolar Hemorrhage. Tuberc Resp Dis (Seoul) 2013. 74(4):151-162
- ↑ 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