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
Bianco A, Mari PV, Larici AR, Lucchini M, Nociti V, Losavio FA, De Fino C, Cicchetti G, Coraci D, Richeldi L, Mirabella M
Alemtuzumab-induced lung injury in multiple sclerosis: Learning from adversity in three patients.
Multiple sclerosis and related disorders 2019 Oct 15;37;101450 — 2019 Oct 15 — 101450
Diffuse alveolar hemorrhage during alemtuzumab infusion in a patient with multiple sclerosis: a case report.
BMC pharmacology & toxicology 2018 Nov 19;19;75 — 2018 Nov 19 — 75
Diffuse Alveolar haemorrhage: a fatal complication after alemtuzumab induction therapy in renal transplantation.
Transplantation proceedings 2015 Jan-Feb;47;151-4 — 2015 Jan-Feb — 151-4
Diffuse alveolar hemorrhage following alemtuzumab.
Chest 2008 Jun;133;1476-1478 — 2008 Jun — 1476-1478