Diffuse Alveolar Hemorrhage

Abstract

Diffuse alveolar hemorrhage (DAH) is a life-threatening and medical emergency that can be caused by numerous disorders and presents with hemoptysis, anemia, and diffuse alveolar infiltrates. Early bronchoscopy with bronchoalveolar lavage is usually required to confirm the diagnosis and rule out infection. Most cases of DAH are caused by capillaritis associated with systemic autoimmune diseases such as anti-neutrophil cytoplasmic antibody-associated vasculitis, anti-glomerular basement membrane disease, and systemic lupus erythematosus, but DAH may also result from coagulation disorders, drugs, inhaled toxins, or transplantation. The diagnosis of DAH relies on clinical suspicion combined with laboratory, radiologic, and pathologic findings. Early recognition is crucial, because prompt diagnosis and treatment is necessary for survival. Corticosteroids and immunosuppressive agents remain the gold standard. In patients with DAH, biopsy of involved sites can help to identify the cause and to direct therapy. This article aims to provide a general review of the causes and clinical presentation of DAH and to recommend a diagnostic approach and a management plan for the most common causes.

Pristane-Induced Granulocyte Recruitment Promotes Phenotypic Conversion of Macrophages and Protects against Diffuse Pulmonary Hemorrhage in Mac-1 Deficiency

“…Several case reports, primarily those based on early autopsy or lung biopsy during the recovery state of the disease, have shown that ICmediated systemic vasculitis is one of the most common causes of SLE-related DPH (38). However, some SLE cases have presented with DPH without pulmonary IC-deposition or serologic disease activity (2).…”

Autoimmune Features of Wiskott-Aldrich Syndrome: A Case Report

“…The causes of diffuse alveolar hemorrhage can be divided into cases associated with capillaritis and those without (Table 2) [7][8][9]. The patient's initial diagnosis prior to this admission was idiopathic pulmonary hemosiderosis, a diagnosis of exclusion, based on initial biopsy where no vessel damage seen.…”

“…Therefore, the patient is currently waiting on compatible cord blood HSCT. Capillaritis is generally associated with systemic autoimmune disease, and capillaritis as an isolated entity is relatively rare [7][8][9]. However, autoimmune diseases are common in WAS (22% to 77%) [5,6] and vasculitis is a known complication of WAS occurring in approximately 20% of patients [7].…”

Alveolar hemorrhagic syndrome in children

“…[1] Морфологические изменения при альвеолярном геморрагическом синдроме могут носить как общий, так и специфический характер. M. Park предлагает вы-делять три гистопатологических паттерна при диф-фузном альвеолярном кровоизлиянии у детей: альвео-лярный геморрагический синдром, ассоциированный с васкулитом или капиляритом, -наиболее частый, характерный для системных заболеваний и васкулитов; альвеолярный геморрагический синдром, не сопрово-ждающийся воспалением или васкулитом, характер-ный, в частности, для идиопатического гемосидероза легких; альвеолярный геморрагический синдром, ас-социированный с другими процессами или состояния-ми, сопровождающийся прямым выходом эритроцитов в ткань легкого без признаков васкулита, свойственный токсическим или лекарственным повреждениям [2].…”