Diffuse Alveolar Hemorrhage: Blood, Sweat and Tears

Excerpt

A 68-year-old woman with systemic sclerosis and interstitial lung disease presented with progressive cough and dyspnea. She was in respiratory distress, with a heart rate of 110 beats per minute, respiratory rate 35, and oxygen saturation 63 % on ambient air, which improved to 94 % with 15 l of 100 % oxygen by face mask. Lungs had diffuse crackles throughout. Lab results revealed hemoglobin of 7.2 g/dL. Her chest x-ray showed multifocal bilateral airspace opacities (Fig. 1). She was intubated; subsequent bronchoscopy revealed progressively hemorrhagic lavage fluid (Fig. 2) indicative of diffuse alveolar hemorrhage (DAH). She was started on high-dose intravenous corticosteroid and cyclophosphamide. Due to ongoing DAH, bleeding was temporized with intravenous aminocaproic acid and intrabronchial activated factor VIIa (rFVIIa).1‐3 Ultimately, she developed ventilator-associated pneumonia and died.

…