The Drug-Induced Respiratory Disease Website
(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
[Alveolar hemorrhage as a complication of thrombolytic therapy].
Medicina 2011;71;547-9 — 2011 — 547-9
Predictors of major hemorrhage following fibrinolysis for acute pulmonary embolism.
The American journal of cardiology 2006 Jan 01;97;127-9 — 2006 Jan 01 — 127-9
Cuéllar Obispo E, Torrado González E, Alvarez Bueno M, Ferriz Martín JA, Vera Almazán A, Rodríguez García JJ
[A diffuse pulmonary hemorrhage following thrombolytic therapy in an acute myocardial infarct].
Revista espanola de cardiologia 1992 Jun-Jul;45;421-4 — 1992 Jun-Jul — 421-4