III.a

Alveolar hemorrhage, diffuse, bland (DAH)

(Fr: hémorragie alvéolaire pure, isolée, sans auto-Ac). Diffuse 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, coaculopathy, ANA- or ANCA- and, less often, anti-GBM-related disease. Pulmonary capillaritis is more often suspected than proved, as the lung biopsy is generally avoided if typical BAL features 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

Last update : 07/04/2017
 

Causative drugs

133