Pulmonary Bleeding Problems

Question 1

Pulmonary haemosiderosis triad

Answer 1

Iron deficiency anaemia, hemoptysis, multiple alveolar infiltrates on CXR

Question 2

Disorders associated with pulmonary capillaritis

Answer 2

SLE
Drug induced capilaritis
Granulomatosis with polyangiitis 
Anti-GBM disease
Henoch Schonlein Purpura

Question 3

Disorders without pulmonary capillaritis

Answer 3

Non CV
- idiopathic pulmonary haemosiderosis
- coag probs
- hemolytic uraemic syn
- celiac
- child abuse 
- infection ( HIV )
- immunodeficiency 
CV
Mitral stenosis 
AVMs
PHTN
CHF

Question 4

Granulomatosis with polyangiitis

Classic characteristcs

Answer 4

Necrotising granuloma formation of upper & lower respiratory tract

Children often present with upper airway problems eg subglottic stenosis

Necrotising glomerulonephritis

Small vessel vasculitis

Question 5

Ab associated with GPA

Answer 5

antiproteinase-3 antibodies

cANCA

Question 6

Define MPA

Two features it lacks which differentiates from other conditions

Antibody associated with MPA

Answer 6

Systemic necrotising vasculitis
Predilection for small vessels

Without granuloma formation
No immune complexes

Venules
Arterioles
Capillaries

antimyeloperoxidase antibodies

pANCA

Question 7

Histological features of pulmonary capillaritis

Answer 7

Fibrin thrombi which occlude capillaries

Fibrin clots adherent to interalveolar septae

Fibrinoid necrosis of capillary wall

Interstitial erythrocytes & haemosiderin

Question 8

Pulmonary haemorrhage labs

Answer 8

Microcytic hypochromic anaemia
Hemolytic anaemia 
Elevated bili
Urinalysis 
ANCA
ds-DNA
ANA, RF, ds-DNA
Coombs

Question 9

Genetic causes of Thrombophilia

Answer 9

Factor V Leiden
Def of ATIII, protein S & C
Antiphospholipid syn
Prothrombin gene mutation 
Hyper homocysteinenemia