II. Pathophysiology

  1. Acute life-threatening diffuse Pulmonary Hemorrhage often due to Vasculitis
  2. Bleeding into the alveoli due to disrupted capillary-alveolar basement membrane

III. Symptoms

  1. Cough
  2. Hemoptysis (66% of patients)
  3. Dyspnea
  4. Chest Pain or chest tightness
  5. Fever

IV. Signs

  1. Anemia (variably present)
  2. Diffuse lung infiltration (may be unilateral)
  3. Acute Respiratory Failure

VII. Differential Diagnosis

VIII. Labs

  1. Initial Labs
    1. Complete Blood Count with Platelet Count
    2. Comprehensive Metabolic Panel
    3. Blood Cultures
    4. C-Reactive Protein
    5. Urinalysis
  2. Vasculitis-Related Labs
    1. Serum ANCA
    2. Ant-GBM Antibodies
    3. Antinuclear Antibody (ANA)
    4. Antiphospholipid Antibody Panel
    5. Consider other rheumatologic and autoimmune Antibody testing

IX. Imaging

  1. Chest XRay
    1. Patchy or diffuse Alveolar Infiltrates
  2. CT Chest
    1. Regions of ground-glass attenuation

X. Diagnostics

  1. Bronchoscopy
    1. Indicated in most cases of acute Diffuse Alveolar Hemorrhage
    2. Send aspirate cultures for Bacterial, fungal and viral organisms

XI. Management

  1. ABC Management
    1. Supplemental Oxygen
    2. Non-Invasive Positive Pressure Ventilation or Mechanical Ventilation as needed
    3. Empiric antibiotic management for infectious cause
  2. High Dose Corticosteroids
    1. Methylprednisolone IV 125 to 250 mg every 6 hours for 4 to 5 days
    2. Consider continued oral Corticosteroids (e.g. Prednisone) for a 5 day course
  3. Immunosuppressants
    1. Cyclophosphamide, Azathioprine, Methotrexate, Mycophenolate and Etanercept have been used
  4. Plasmapheresis
    1. May be indicated in Vasculitis (e.g. Goodpasture's Syndrome)

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