Diffuse Alveolar Hemorrhage

Brandi R. Newsome, MD; Juan E. Morales, MD

Disclosures

South Med J. 2011;104(4):269-274. 

In This Article

Treatment

The treatment of DAH depends on the underlying cause of hemorrhage. Corticosteroids are a mainstay of therapy in most cases. However, the majority of the cases of drug-induced DAH and those related to exposures can be treated with withdrawal of the toxin alone. There is growing literature supporting the use of activated recombinant factor VII (rFVIIa) to stop active pulmonary hemorrhage. Heslet el al reported six cases of DAH in which intrapulmonary (50 ug/kg) rFVIIa was used with good success. All six patients had improvement in oxygenation and no side affects or thrombotic complications were noted.[8] Prior to this series, only intravenous rFVIIa had been attempted for DAH. Estella et al demonstrated similar efficacy and lack of side affects with intrapulmonary use in two cases in 2008.[9] The limiting factors in its use include the prohibitive cost (approx $1 per microgram, lack of FDA approval for DAH specifically and the theoretical risk of thrombotic complications. Transexamic acid (TXA) is an inexpensive, synthetic anti-fibrinolytic agent that has been useful in controlling bleeding from oral and cardiac surgery.[10,11] Researchers successfully used both aerosolized and intrapulmonary injections of transexamic acid to control six cases of DAH of different etiologies.[12] Several sources cite increased risk of post-operative seizures in patient who received TXA. A large study of patients given TXA during cardiac surgery found TXA had higher rates of seizures, need for transfusions and mortality compared to aprotenin, which has been taken off the market.

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