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Immune diffuse alveolar hemorrhage: Clinical presentation and outcome
Silvia Quadrelli1, Diana Dubinsky1, Marco Solis1
1Sanatorio Güemes University Hospital, Buenos Aires, Argentina.
Respiratory Medicine
|July 23, 2017
Summary
Immune-mediated diffuse alveolar haemorrhage (DAH) often presents without hemoptysis and requires prompt bronchoscopy. High mortality is linked to dialysis, low oxygen saturation, and mechanical ventilation needs in DAH patients.
Area of Science:
- Pulmonology
- Rheumatology
- Critical Care Medicine
Background:
- Diffuse alveolar haemorrhage (DAH) is a serious lung condition stemming from various immune and non-immune diseases.
- Immune-mediated DAH, particularly when severe enough to require hospitalization, necessitates a thorough understanding of its clinical spectrum and outcomes.
Purpose of the Study:
- To characterize the clinical features of patients hospitalized with immune-mediated DAH.
- To evaluate the short-term outcomes of these patients.
- To identify factors associated with mortality in hospitalized DAH patients.
Main Methods:
- A retrospective analysis of 39 patients with immunologically confirmed DAH admitted between December 2010 and December 2015.
- Diagnosis of underlying collagen vascular diseases (CVD) followed established criteria.
- Clinical data, including symptoms, laboratory findings, bronchoscopy results, treatments, and outcomes, were reviewed.
Main Results:
- ANCA-associated vasculitis was the primary cause (74.3%), predominantly granulomatosis with polyangiitis and microscopic polyangiitis.
- Hemoptysis occurred in 76.9% of patients; alveolar filling patterns were common (59%).
- All patients experienced a hemoglobin drop; 100% showed siderophagic alveolitis on BAL cytology. High-dose corticosteroids were universal, with varied additional immunosuppressants and supportive care. Mortality was significantly higher in patients requiring dialysis (50.0%), with initial SaO2 <90% (50.0%), or mechanical ventilation (76.9%).
Conclusions:
- Immune-mediated DAH can manifest without hemoptysis and warrants early bronchoscopy to rule out infection and establish diagnosis.
- Factors such as the need for dialysis, mechanical ventilation, and low initial oxygen saturation are critical indicators of poor prognosis.
- Timely diagnosis and aggressive management, including immunosuppression and respiratory support, are crucial for improving outcomes in severe DAH.
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