DIFFUSE ALVEOLAR HAEMORRHAGE

1. DR ASHRAF AHMAD
PULMONOLOGIST
KAASH - TAIF
2015
DIFFUSE ALVEOLAR HAEMORRHAGE

2. INTRODUCTION
Bleeding into the alveolar spaces characterizes the
syndrome of DAH and is due to disruption of the
alveolar-capillary basement membrane. This is
caused by injury or inflammation of the
arterioles, venules, or alveolar septal (alveolar
wall or interstitial) capillaries. Hemoptysis is the
usual presenting symptom; however it is not
always present, even when hemorrhage is severe

7. CLINICAL PRESENTATION
 Symptoms :Cough, hemoptysis, fever, and dyspnea
are common initial symptoms. Some patients,
however, present with ARDS requiringMV
 Physical examination: The pulmonary examination
is usually nonspecific, unless there are physical
signs of an underlying systemic vasculitis or CT
vascular disorder

8. INVESTIGATIONS
 Radiological:
 PFTs: increased DLCO
 BAL :sequential lavage are progressively more
hemorrhagic with hemosiderin-ladenMQ.
 Biopsy from the affected tissue

12. TREATMENT
=TTT CAUSE
 Glucocorticoids : are the mainstay of therapy for
the DAH syndrome associated with systemic
vasculitis, connective tissue disease, Goodpasture's
syndrome, and isolated pulmonary capillaritis.
 Additional immunosuppressive
agents (cyclophosphamide or azathioprine)
 Plasma exchange : in Goodpasture's syndrom

13.  Experimental TTT:
IVIG, rituximab , aminocaproic acid &
Recombinant human coagulation factor VIIa