الفهرس | Only 14 pages are availabe for public view |
Abstract Introduction: Diffuse alveolar hemorrhage (DAH) is a distinct clinicopathologic syndrome of pulmonary hemorrhage that originates from the pulmonary microcirculation, including the alveolar capillaries, arterioles, and venules. It presents with hemoptysis, anemia, diffuse lung infiltration, and acute respiratory failure. The diagnosis is confirmed by the observation of the accumulation of red blood cells (RBCs), fibrin, or hemosiderin-laden macrophage in the alveolar space on pathologic biopsy. Therapy for DAH consists of treating both the autoimmune destruction of the alveolar capillary membrane and the underlying condition. Corticosteroids (CS) and immunosuppressive agents remain the gold standard for most patients. Recombinant-activated human factor VII seems to be a promising new therapy, but further evaluation is needed. Plasmapheresis (PE) is indicated for DAH in special situations Aim of the Essay: The aim of this essay is to discuss the main causes, differential diagnosis, diagnosis and specific management of diffuse alveolar hemorrhage in ICU patients. Summary: For patients with DAH due to capillaritis that is suspected to be due to systemic vasculitis, rheumatic disease, or anti-glomerular basement membrane disease, treatment is initiated promptly with systemic glucocorticoids, as glucocorticoids are part of the initial regimens for all of these diseases, additional immune-suppressive therapy may be needed (eg, cyclophosphamide, rituximab, plasma exchange), which is selected according to guidelines for the individual diseases. |