Philippe Camus, M.D.

Dijon, France

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XVI.e

Alveolar hemorrhage (AH), diffuse AH (DAH)

(Fr: hémorragie alvéolaire pure, isolée, sans auto-Ac). Diffuse bland alveolar hemorrhage (DAH). Can be severe or fatal (PMID 26236607). When unassociated with pulmonary vasculitis or capillaritis, the condition is named bland diffuse alveolar hemorrhage (DAH). Caution: hemosiderin-laden BAL macrophages can be found in DAD (PMID 19129275). Laboratory clues to this condition include ANA, ANCA, platelets and coagulation studies (INR, and full blood count). DAH may unravel thrombocytopenia (that may be drug-induced), coaculopathy, ANA- or ANCA- and, less often, anti-GBM-(drug)-related disease. Pulmonary capillaritis is more often suspected than proved, as the lung biopsy is generally avoided if typical gross BAL features for AH are present. ANCA of MPO-, HNE- or, less often, -PR3 with multispecificity and high titers suggest the drug etiology. Drug-induced DAH can mimic primary ANCA-related micropolyangiitis or 'Wegener's'. See PMID 19592204, 20442117, 21606695, 21674416. A search for underlying pulmonary condition at the origin of hemorrhage (e.g. lung cancer, bronchiectasis) is indicated. See also under IIIb, VId, Xs, Xz, XVIIv. 2018 review @PMID 30404115

Publications

Mohan S, Kumar R, Ish P, Kaushik R, Talukdar T, Gupta N, Gupta N

Diffuse alveolar hemorrhage: a retrospective study from a tertiary care center.

Monaldi archives for chest disease = Archivio Monaldi per le malattie del torace 2024 Oct 28;; — 2024 Oct 28

Oualim S, Elharda CA, Benzeroual D, Hattaoui ME

Pulmonary alveolar hemorrhage mimicking a pneumopathy: a rare complication of dual antiplatelet therapy for ST elevation myocardial infarction.

The Pan African medical journal 2016;24;308 — 2016 — 308

Kim Y, Lim J, Lim J, Kim S, Jung T, Choi W

Pulmonary Alveolar Hemorrhage after Clopidogrel Use for ST Elevation Myocardial Infarction.

Korean circulation journal 2013 Jul;43;497-9 — 2013 Jul — 497-9

Borderías Clau L, Garrapiz López J, Caballero G

[Pulmonary haemorrhage and haemothorax after massive ingestion of clopidogrel as a suicide attempt].

Archivos de bronconeumologia 2009 Nov;45;570-1 — 2009 Nov — 570-1

Gill DS, Ng K, Ng KS

Massive pulmonary haemorrhage complicating the treatment of acute coronary syndrome.

Heart (British Cardiac Society) 2004 Mar;90;e15 — 2004 Mar — e15

Kilaru PK, Schweiger MJ, Kozman HA, Weil TR

Diffuse alveolar hemorrhage after clopidogrel use.

The Journal of invasive cardiology 2001 Jul;13;535-7 — 2001 Jul — 535-7