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
Ben Mrad I, Ben Mrad M, Oumaya Z, Zairi I, Besbes B, Ouaghlani K, Kamoun S, Mleyhi S, Miri R, Mzoughi K, Kraiem S
Alveolar Hemorrhage Following Thrombolytic Therapy for Acute Myocardial Infarction: Two Case Reports and Literature Review.
Open access emergency medicine : OAEM 2021;13;399-405 — 2021 — 399-405
Pulmonary haemorrhage following thrombolysis with streptokinase in myocardial infarction.
BMJ case reports 2020 Jan 23;13; — 2020 Jan 23
[Alveolar hemorrhage as a complication of thrombolytic therapy].
Medicina 2011;71;547-9 — 2011 — 547-9
Diffuse alveolar hemorrhage following thrombolytic therapy for acute myocardial infarction.
Respiration; international review of thoracic diseases 2000;67;445-8 — 2000 — 445-8
Diffuse pulmonary hemorrhage after fibrinolytic therapy for acute myocardial infarction.
International journal of cardiology 1998 Jan 05;63;95-7 — 1998 Jan 05 — 95-7
Diffuse pulmonary hemorrhage after streptokinase administration for acute myocardial infarction.
Pharmacotherapy 1997 Mar-Apr;17;390-4 — 1997 Mar-Apr — 390-4
Spontaneous pulmonary hemorrhage after thrombolytic therapy for acute myocardial infarction.
Chest 1994 Nov;106;1622-4 — 1994 Nov — 1622-4
Pulmonary hemorrhage following intravenous streptokinase for acute myocardial infarction.
International journal of cardiology 1990 Dec;29;387-90 — 1990 Dec — 387-90