Pearls from Dr. Bill Bulman
Diffuse alveolar hemorrhage syndromes
- bleeding into alveolar spaces of the lungs due to disruption of the alveolar-capillary basement membrane
- hemoptysis can be present as the presenting symptom but also possible to have considerable DAH without any hemoptysis or Hct drop
- 3 histopathologic patters
Posted 11/30/16 10:09:27 AM by Anna Krigel
Diagnostic evaluation of DAH
- Can tell blood from another consolidating process on imaging using DLCO (an increase above 100% of predicted is sensitive marker for DAH)
- Sequential bronchoalveolar lavage - preferred method for diagnosis of DAH
- instill and retrieve 3 sequential aliquots of 50 to 60 ml sterile saline into a subsegmental bronchus where opacities are seen on imaging
- alveolar hemorrhage confirmed when lavage aliquots are progressively more hemorrhagic
Posted 11/30/16 10:11:55 AM by Anna Krigel
Treatment of DAH with capillaritis due to systemic vasculitis
- Glucocorticoids - initiated promptly, typically IV pulse methyprednisolone
- Additional immunosuppressive therapy with cyclophosphamide or rituximab
Posted 11/30/16 10:47:36 AM by Anna Krigel
For further reading...
Posted 11/30/16 11:06:10 AM by Anna Krigel
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