Diffuse Alveolar Haemorrhage

Question 1

Diffuse Alveolar Haemorrhage
Diagnostic approach

Answer 1

Diagnosis is suggested by dyspnea, cough, and hemoptysis accompanied by chest x-ray findings of diffuse bilateral alveolar infiltrates and a suspicion of diffuse alveolar hemorrhage.

1) Chest x-ray
2) Bronchoalveolar lavage
- haemorrhagic sequential lavage
3) Serologic test - ANA, anti-dsDNA, anti-GBM, ANCA, antiphospholipid antibody, complement levels
4) UFEME
- to exclude glomerulonephritis and the pulmonary-renal syndrome;
5) FBC, RP, LFT, coag
6) Echocardiography may be indicated to exclude mitral stenosis.
7) Lung biopsy or, if the urinalysis is abnormal, kidney biopsy may be needed when a cause remains unclear or the progression of disease is too rapid to await the results of serologic testing.

Question 2

Diffuse Alveolar Haemorrhage
Causes

Answer 2

1) Autoimmune disorders (eg, systemic vasculitides, Goodpasture syndrome, antiphospholipid syndrome, systemic rheumatic disorders)
2) Cardiac disorders (eg, mitral stenosis)
3) Coagulation disorders caused by diseases or anticoagulant medications
4) Hematopoietic stem cell transplantation or solid organ transplantation
5) Idiopathic pulmonary hemosiderosis
6) Isolated pauci-immune pulmonary capillaritis
7) Pulmonary infections
8) Reactions to medications (eg, propylthiouracil, amiodarone, methotrexate, nitrofurantoin, montelukast, infliximab)
9) Toxic exposures (eg, trimellitic anhydride, isocyanates, crack cocaine, certain pesticides, vaping)

Question 3

Diffuse Alveolar Haemorrhage
Treatment

Answer 3

1) Immunosuppressants e.g. Corticosteroid, cyclophosphamide, rituximab, or plasma exchange
- to treat vasculitides, systemic rheumatic disorders, and Goodpasture syndrome

2) Supportive measures:
supplemental oxygen,
bronchodilators,
reversal of any coagulopathy, and
IMV

3) Treatment involves correcting the cause.