Advertisement

Diffuse Alveolar Hemorrhage in Critically Ill Cancer Patients

  • Brian W. Stephenson
  • Allen H. RobertsII
  • Charles A. ReadEmail author
Reference work entry

Abstract

Diffuse alveolar hemorrhage (DAH) is a syndrome classically defined by the triad of anemia, hemoptysis, and bilateral infiltrates on chest imaging. DAH can progress rapidly toward respiratory failure and death. It is paramount that critical care practitioners be familiar with the diagnosis and treatments available for this syndrome. This chapter reviews the etiologies of DAH, the pathophysiology, the clinical presentation, and diagnostic evaluation, and concludes with the evidence supporting treatment options with a focus on DAH in the oncologic patient. The reader will be able to distinguish infectious, bland hemorrhage, and connective tissue disease-associated causes of DAH from those caused by cytotoxic drugs and graft versus host disease (GVHD). With appropriate and timely treatment, the prognosis of DAH can be dramatic improved.

Keywords

Diffuse alveolar hemorrhage alveolar infiltrates hemoptysis respiratory failure vasculitis 

References

  1. 1.
    Aakjaer S, et al. Continuous rituximab treatment for recurrent diffuse alveolar hemorrhage in a patient with systemic lupus erythematosus and antiphospholipid syndrome. Respirat Med Case Rep. 2017;22:263–5.Google Scholar
  2. 2.
    Abousouan L, Ricauarte B. Noninvasive positive pressure ventilation: increasing use in acute care. Cleve Clin J Med. 2015;77(5):307–16.CrossRefGoogle Scholar
  3. 3.
    Afridi F, et al. High-frequency oscillatory ventilation in diffuse alveolar hemorrhage of ANCA-associated vasculitis. Crit Care Med. 2018;46((1) Supplement):512.CrossRefGoogle Scholar
  4. 4.
    Ahmed S, et al. Use of extracorporeal membrane oxygenation in a patient with diffuse alveolar hemorrhage. Chest. 2004;126(1):305–9.CrossRefGoogle Scholar
  5. 5.
    Alabed A. Treatment of diffuse alveolar hemorrhage in systemic lupus erythematosus with local pulmonary instillation of factor VIIa (rFVIIa). Medicine. 2014;93(14):1–4.CrossRefGoogle Scholar
  6. 6.
    Baker M, et al. Intrapulmonary recombinant factor VII as an effective treatment for diffuse alveolar hemorrhage: a case series. J Bronchol Intervent Pulmonol. 2016;23(3):255–8.CrossRefGoogle Scholar
  7. 7.
    Brodie D, et al. Research in extracorporeal life support: a call to action. Chest. 2018;153(4):788–91.CrossRefGoogle Scholar
  8. 8.
    Claudie C, et al. Extracorporeal membrane oxygenation in diffuse alveolar hemorrhage secondary to systemic lupus erythematosus. J Clin Med Res. 2014;6(2):145–8.Google Scholar
  9. 9.
    Colby T, et al. Pathologic approach to pulmonary hemorrhage. Ann Diagn Pathol. 2001;5(5):309–19.CrossRefGoogle Scholar
  10. 10.
    Collard HR, Schwarz MI. Diffuse alveolar hemorrhage. Clin Chest Med. 2004;25:583–92.CrossRefGoogle Scholar
  11. 11.
    Collard HR, King TE, Schwarz MI. Alveolar hemorrhage and rare infiltrative diseases. In: Broaddus C, editor. Murray and Nadel’s textbook of respiratory medicine. Philadelphia: Saunders, an imprint of Elsevier Inc.; 2016. p. 67.1207–1220.e11.Google Scholar
  12. 12.
    Duval ELIM, Markhorst DG, Ramet J, van Vught AJ. High-frequency oscillatory ventilation in severe lung hemorrhage: a case study of three centres. Respirat Med CME. 2009;2:92–8.CrossRefGoogle Scholar
  13. 13.
    Elinoff J, et al. Recombinant human factor viia for alveolar hemorrhage following allogeneic stem cell transplantation. Biol Blood Marrow Transplant. 2014;20:969–78.CrossRefGoogle Scholar
  14. 14.
    El-Khatib M, Bou-Khalil P. Clinical review: liberation from mechanical ventilation. Crit Care. 2008;12(221):1–11, Available at http://ccforum.com/content/12/4/221Google Scholar
  15. 15.
    Escuissatoa DL, Warszawiaka D, Marchiorib E. Differential diagnosis of diffuse alveolar haemorrhage in immunocompromised patients. Curr Opin Infect Dis. 2015;28:337–42.CrossRefGoogle Scholar
  16. 16.
    Frawley P, Habashi N. Airway pressure release ventilation: theory and practice. AACN Clin Issues. 2001;12(2):234–46.CrossRefGoogle Scholar
  17. 17.
    Gattinoni L, et al. Prone position in acute respiratory distress syndrome: rationale, indications and limits. AJRCCM. 2013;188(11):1286–93.Google Scholar
  18. 18.
    Greening A, Hughes J. Serial estimations of carbon monoxide diffusion capacity in intrapulmonary haemorrhage. Clin Sci. 1981;60:507–12.CrossRefGoogle Scholar
  19. 19.
    Hafner S, et al. Hyperoxia in intensive care, emergency, and peri-operative medicine: Dr. Jekyll or Mr. Hyde – a 2015 update. Ann Intensive Care. 2015;5(42):1–14.Google Scholar
  20. 20.
    Hayes-Bradley C. Hypoxia from vasculitic pulmonary haemorrhage improved by prone position ventilation. Br J Anaesth. 2004;92(5):754–7.CrossRefGoogle Scholar
  21. 21.
    Hughes KT, Beasley MB. Pulmonary manifestations of acute lung injury: more than just diffuse alveolar damage. Arch Pathol Lab Med. 2017;141(7):916–22.CrossRefGoogle Scholar
  22. 22.
    Jackson W. Should we use etomidate as an induction agent for endotracheal intubation in patients with septic shock? Chest. 2005;127(3):1031–8.CrossRefGoogle Scholar
  23. 23.
    Klemmer P, et al. Plasmapheresis therapy for diffuse alveolar hemorrhage in patients with small-vessel vasculitis. Am J Kidney Dis. 2003;42(6):1149–53.CrossRefGoogle Scholar
  24. 24.
    Krause M, et al. Update on diffuse alveolar hemorrhage and pulmonary vasculitis. Immunol Allergy Clin N Am. 2012;32(4):587–600.CrossRefGoogle Scholar
  25. 25.
    Lara AR, Schwarz MI. Diffuse alveolar hemorrhage. Chest. 2010;137(5):1164–71.CrossRefGoogle Scholar
  26. 26.
    Makdisi G, Wang I. Extra corporeal membrane oxygenation (ECMO) review of a lifesaving technology. J Thorac Dis. 2015;7(7):E166–76.PubMedPubMedCentralGoogle Scholar
  27. 27.
    Mark E, Ramirez J. Pulmonary capillaritis and hemorrhage in patients with systemic vasculitis. Arch Pathol Lab Med. 1985;109:413–8.PubMedGoogle Scholar
  28. 28.
    Mat Nor MB, Md Ralib A, Ibrahim NA, Abdul-Ghani MR. High frequency oscillatory ventilation in leptospirosis pulmonary hemorrhage syndrome: a case series study. Indian J Crit Care Med. 2016;20(6): 342–8.CrossRefGoogle Scholar
  29. 29.
    Mauri T, et al. Physiologic effects of high-flow oxygen by nasal cannula in hypoxemic respiratory failure. AJRCCM. 2016;195(9):1207–15.Google Scholar
  30. 30.
    Moon KM, et al. Diffuse alveolar hemorrhage confirmed by Bronchoalveolar lavage in a patient with hemoptysis after sildenafil use for erectile dysfunction. Korean J Crit Care Med. 2015;30:31–3.CrossRefGoogle Scholar
  31. 31.
    Narshi C, et al. Rituximab as early therapy for pulmonary hemorrhage in systemic lupus erythematosus. Rheumatology. 2010;49:394–6.CrossRefGoogle Scholar
  32. 32.
    Nguyen T, et al. Plasmapheresis for diffuse alveolare hemorrhage in a patient with Wegener’s granulomatosis: case report and review of the literature. J Clin Apher. 2005;20(4):230–4.CrossRefGoogle Scholar
  33. 33.
    Nguyen AP, Schmidt UH, MacIntyre NR. Should high-frequency ventilation in the adult be abandoned? Respir Care. 2016;61(6):791–800.CrossRefGoogle Scholar
  34. 34.
    O’Connor M, Glick D. Chapter 45: airway management. Principles of critical care. 4th ed. New York: McGraw Hill Education; 2015. p. 384–96.Google Scholar
  35. 35.
    Ozaki Y, Nomura S. Chapter XI: Airway pressure support ventilation (APRV) as supportive management for diffuse alveolar hemorrhage in systemic lupus erythematosus. Lupus: Symptoms, Treatments, and Potential Complications Nova Science Publishers Inc.; 2012. p. 197–203.Google Scholar
  36. 36.
    Park M. Diffuse alveolar hemorrhage. Tuberc Respir Dis. 2013;74:151–62.CrossRefGoogle Scholar
  37. 37.
    Pathak V, et al. Use of activated factor VII in patients with diffuse alveolar hemorrhage: a 10 years institutional experience. Lung. 2015;193:375–9.CrossRefGoogle Scholar
  38. 38.
    Pham T, et al. Mechanical ventilation: state of the art. Mayo Clin Proc. 2017;92(9):1382–400.CrossRefGoogle Scholar
  39. 39.
    Pihusch M, et al. Recombinant activated factor VII in treatment of bleeding complications following hematopoietic stem cell transplantation. J Thromb Haemost. 2005;3:1935–44.CrossRefGoogle Scholar
  40. 40.
    Rathi N, et al. Low-, medium- and high-dose steroids with or without aminocaproic acid in adult hematopoietic SCT patients with diffuse alveolar hemorrhage. Bone Marrow Transplant. 2015;50:420–6.CrossRefGoogle Scholar
  41. 41.
    Ravindran V, Watts R. Pulmonary haemorrhage in ANCA-associated vasculitis. Rheumatology. 2010;49:1412–4.CrossRefGoogle Scholar
  42. 42.
    Shwarz M, Brown K. Small vessel vasculitis of the lung. Thorax. 2000;55:402–510.Google Scholar
  43. 43.
    Sinclair R, Luxton M. Rapid sequence induction. Br J Anaesth. 2005;5(2):65–6.Google Scholar
  44. 44.
    The Acute Respiratory Distress Syndrome Network. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. NEJM. 2000;342:1301–8.CrossRefGoogle Scholar
  45. 45.
    Travis W, Colby T, Lombard C, Carpenter H. A clincopathologic study of 34 cases of diffuse pulmonary hemorrhage with biopsy confirmation. Am J Surg. 1990;14:1112–25.Google Scholar
  46. 46.
    Tse J, et al. Rituximab: an emerging treatment for recurrent diffuse alveolar hemorrhage in systemic lupus erythematosus. Lupus. 2015;24(7):756–9.CrossRefGoogle Scholar
  47. 47.
    Wanko S, et al. Diffuse alveolar hemorrhage: retrospective review of clinical outcome in allogeneic transplant recipients treated with Aminocaproic acid. Biol Blood Marrow Transplant. 2006;12:949–53.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Brian W. Stephenson
    • 1
  • Allen H. RobertsII
    • 1
  • Charles A. Read
    • 1
    Email author
  1. 1.Division of Pulmonary, Critical Care, and Sleep MedicineDepartment of Medicine, MedStar Georgetown University HospitalWashingtonUSA

Section editors and affiliations

  • Yenny Cardenas
    • 1
  1. 1.Critical Care DepartmentUniversidad del Rosario Hospital Universitario Fundacion Santa Fe deBogotaColombia

Personalised recommendations