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
Diffuse Alveolar Hemorrhage Associated with Warfarin Therapy.
Case reports in medicine 2015;2015;350532 — 2015 — 350532
de Prost N, Parrot A, Cuquemelle E, Picard C, Antoine M, Fleury-Feith J, Mayaud C, Boffa JJ, Fartoukh M, Cadranel J
Diffuse alveolar hemorrhage in immunocompetent patients: etiologies and prognosis revisited.
Respiratory medicine 2012 Jul;106;1021-32 — 2012 Jul — 1021-32
Diffuse alveolar hemorrhage with acute respiratory distress syndrome associated with phenprocoumon therapy.
Blood coagulation & fibrinolysis : an international journal in haemostasis and thrombosis 2008 Dec;19;813-5 — 2008 Dec — 813-5
Sirolimus-associated diffuse alveolar hemorrhage in a renal transplant recipient on long-term anticoagulation.
Clinical nephrology 2007 Oct;68;238-44 — 2007 Oct — 238-44
Alveolar hemorrhage associated with warfarin therapy: a case report and literature review.
The international journal of cardiovascular imaging 2004 Apr;20;155-9 — 2004 Apr — 155-9
Acute dyspnea, chest tightness, and anemia in a 33-year-old man.
Chest 1995 Mar;107;863-5 — 1995 Mar — 863-5
[Occult intrapulmonary hemorrhage caused by anticoagulants].
Annales de l'anesthesiologie francaise 1981;22;53-6 — 1981 — 53-6
Occult pulmonary hemorrhage in anticoagulated patients.
The American review of respiratory disease 1975 Jul;112;23-9 — 1975 Jul — 23-9