Tuberc Respir Dis.  2013 Apr;74(4):151-162. 10.4046/trd.2013.74.4.151.

Diffuse Alveolar Hemorrhage

• Park MS

• KMID: 1495855
• DOI: http://doi.org/10.4046/trd.2013.74.4.151

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.

Keyword

Pulmonary Alveoli; Hemorrhage; Capillaries; Vasculitis; Antibodies, Antineutrophil Cytoplasmic; Diagnosis; Review

MeSH Terms

Adrenal Cortex Hormones
Anemia
Anti-Glomerular Basement Membrane Disease
Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis
Antibodies, Antineutrophil Cytoplasmic
Autoimmune Diseases
Biopsy
Bronchoalveolar Lavage
Bronchoscopy
Capillaries
Emergencies
Hemoptysis
Hemorrhage
Humans
Immunosuppressive Agents
Lupus Erythematosus, Systemic
Pulmonary Alveoli
Transplants
Vasculitis
Adrenal Cortex Hormones
Antibodies, Antineutrophil Cytoplasmic
Immunosuppressive Agents

Figure

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  Figure 1 Diagnostic approach in patients with diffuse alveolar hemorrhage. FOB: fiberoptic bronchoscopy; BAL: bronchioloalveolar lavage; Bx: biopsy; Cx: culture; DAH: diffuse alveolar hemorrhage; Dx: diagnosis; Hx: history; CHF: congestive heart failure; MV: mitral valve; BM: bone marrow; ANA: anti-nuclear antibody; U/A: urinalysis; ANCA: anti-neutrophil cytoplasmic antibodies; RF: rheumatic factor; ESR: erythrocyte sedimentation rate; Cr: creatinine; GBM: glomerular basement membrane; APL: anti-phospholipid; Ab: antibody.

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