바로가기메뉴

본문 바로가기 주메뉴 바로가기

Diffuse Alveolar Hemorrhage

Tuberculosis & Respiratory Diseases / Tuberculosis & Respiratory Diseases,
2013, v.74 no.4, pp.151-162

  • Downloaded
  • Viewed

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.

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

Reference

1.

Collard HR, Schwarz MI. Diffuse alveolar hemorrhage. Clin Chest Med 2004;25:583-92.

2.

Colby TV, Fukuoka J, Ewaskow SP, Helmers R, Leslie KO. Pathologic approach to pulmonary hemorrhage. Ann Diagn Pathol 2001;5:309-19.

3.

Lara AR, Schwarz MI. Diffuse alveolar hemorrhage. Chest 2010;137:1164-71.

4.

Ioachimescu OC, Stoller JK. Diffuse alveolar hemorrhage: diagnosing it and finding the cause. Cleve Clin J Med 2008;75:258-80.

5.

Cordier JF, Cottin V. Alveolar hemorrhage in vasculitis: primary and secondary. Semin Respir Crit Care Med 2011;32:310-21.

6.

Brown KK. Pulmonary vasculitis. Proc Am Thorac Soc 2006;3:48-57.

7.

Newsome BR, Morales JE. Diffuse alveolar hemorrhage. South Med J 2011;104:269-74.

8.

Ewan PW, Jones HA, Rhodes CG, Hughes JM. Detection of intrapulmonary hemorrhage with carbon monoxide uptake: application in goodpasture's syndrome. N Engl J Med 1976;295:1391-6.

9.

Specks U. Diffuse alveolar hemorrhage syndromes. Curr Opin Rheumatol 2001;13:12-7.

10.

Schnabel A, Holl-Ulrich K, Dalhoff K, Reuter M, Gross WL. Efficacy of transbronchial biopsy in pulmonary vaculitides. Eur Respir J 1997;10:2738-43.

11.

Travis WD, Colby TV, Lombard C, Carpenter HA. A clinicopathologic study of 34 cases of diffuse pulmonary hemorrhage with lung biopsy confirmation. Am J Surg Pathol 1990;14:1112-25.

12.

Fauci AS, Haynes BF, Katz P, Wolff SM. Wegener's granulomatosis: prospective clinical and therapeutic experience with 85 patients for 21 years. Ann Intern Med 1983;98:76-85.

13.

Jayne D. Evidence-based treatment of systemic vasculitis. Rheumatology (Oxford) 2000;39:585-95.

14.

Frankel SK, Schwarz MI. The pulmonary vasculitides. Am J Respir Crit Care Med 2012;186:216-24.

15.

Klemmer PJ, Chalermskulrat W, Reif MS, Hogan SL, Henke DC, Falk RJ. Plasmapheresis therapy for diffuse alveolar hemorrhage in patients with small-vessel vasculitis. Am J Kidney Dis 2003;42:1149-53.

16.

Henke D, Falk RJ, Gabriel DA. Successful treatment of diffuse alveolar hemorrhage with activated factor VII. Ann Intern Med 2004;140:493-4.

17.

Ahmed SH, Aziz T, Cochran J, Highland K. Use of extracorporeal membrane oxygenation in a patient with diffuse alveolar hemorrhage. Chest 2004;126:305-9.

18.

Keogh KA, Wylam ME, Stone JH, Specks U. Induction of remission by B lymphocyte depletion in eleven patients with refractory antineutrophil cytoplasmic antibody- associated vasculitis. Arthritis Rheum 2005;52: 262-8.

19.

Jayne D, Rasmussen N, Andrassy K, Bacon P, Tervaert JW, Dadoniene J, et al. A randomized trial of maintenance therapy for vasculitis associated with antineutrophil cytoplasmic autoantibodies. N Engl J Med 2003;349:36-44.

20.

Stone JH, Tun W, Hellman DB. Treatment of non-life threatening Wegener's granulomatosis with methotrexate and daily prednisone as the initial therapy of choice. J Rheumatol 1999;26:1134-9.

21.

Wegener's Granulomatosis Etanercept Trial (WGET) Research Group. Etanercept plus standard therapy for Wegener's granulomatosis. N Engl J Med 2005;352: 351-61.

22.

Specks U. Chapter 22. Pulmonary vasculitis. In: Schwarz MI, King TE Jr, editors. Interstitial lung disease. 4th ed. Hamilton: BC Decker Inc.; 2003. p. 599-631.

23.

Lynch JP, Leatherman. Chapter 77. Alveolar hemorrhage syndrome. In: Fisherman AP, Elias JA, Fishman JA, Grippi MA, Senior RM, Pack AI, editors. Fishman's pulmonary diseases and disorders. 4th ed. New York: McGraw Hill Inc.; 2008. p. 1281-97.

24.

Ahn JH. Pulmonary vasculitis. Tuberc Respir Dis 2000 48:825-36.

25.

Chang TW. Chapter 10-3. Pulmonary vasculitis and diffuse alveolar hemorrhage syndrome. In: The Korean Academy of Tuberculosis and Respiratory Diseases, editor. Respiratory diseases. Seoul: Koonja Publishing Inc.; 2004. p. 549-61.

26.

Betensley AD, Yankaskas JR. Factor viia for alveolar hemorrhage in microscopic polyangiitis. Am J Respir Crit Care Med 2002;166:1291-2.

27.

Channick RN, Rubin LJ. Chapter 49. Pulmonary vasculitis and primary pulmonary hypertension. In: Mason RJ, Broaddus VC, Murray JF, Nadel JA, editors. Murray and Nadel's textbook of respiratory medicine. 4th ed. Philadelphia: Elsevier Saunders Inc.; 2005. p. 1459-65.

28.

Travis WD, Koss MN. Pulmonary vasculitis. In: Dail DH, Hammar SP, editors. Pulmonary pathology. 2nd ed. Berlin: Springer-Verlag, Inc.; 1994. p. 1027-95.

29.

Kang KH. Diffuse alveolar hemorrhage syndrome. In: Tuberc Respir Dis Workshop, 1999 Nov 13, Seoul, Korea. Seoul: The Korean Academy of Tuberculosis and Respiratory Disease; 1999. p. 43-52.

Tuberculosis & Respiratory Diseases