23 yo F with DAH possibly 2/2 new diagnosis of SLE, placed on VV-ECMO
Dr. Madhavi Parekh | Morning Report | 05/22/2017
Splinter hemorrhages = microthrombi in nail bed. Can be seen with any microthrombotic process where patient is showering thrombi. Most commonly associated with endocarditis, however can get with any microthrombotic process. Not usually seen as a result of ECMO.
Posted 05/22/17 09:54:11 AM by Emily Miller
When a patient is on ECMO, can usually decrease tidal volume significantly, especially for people with compliance issues. Patients might be as low as 2-3cc/kg.
Posted 05/22/17 09:54:58 AM by Emily Miller
DAH is caused by disruption of capillaries. Diagnosed during bronchosocpy. Place bronchoscope as distal as possible, instill saline and pull back. Do for serial aliquots. If samples become progressively more bloody, suggestive of disruption of alveolar/capillary membrane and DAH. if become progressively clearer, likely that bleeding is from bronchiole or larger airway.
Posted 05/22/17 09:58:33 AM by Emily Miller
Pulmonary hemorrhage is a rare complication of SLE. Usually seen in people with a known diagnosis of lupus and not as initial presentation. Treatment is high dose steroids followed by immunosuppressant such as Cytoxan. There is less data to support plasmapheresis in these patients.