TY  - CHAP
M1  - Book, Section
TI  - Diseases and Pathophysiology in Pulmonology
A1  - Huppert, Laura A.
A1  - Dyster, Timothy G.
PY  - 2021
T2  - Huppert’s Notes: Pathophysiology and Clinical Pearls for Internal Medicine
AB  - Definition:  Bleeding  into  the  alveolar  space  due  to  disruption  of  the  alveolar–capillary  basement  membraneEtiologies:  See  Table  2.5Clinical  presentation:-  Cough,  fever,  hemoptysis,  or  diffuse  GGOs  +  other  concerning  features  (e.g.,  extrapulmonary  signs  of  vasculitis,  known  condition  associated  with  DAH,  declining  hemoglobin  without  clear  reason)-  Pearl:  Hemoptysis  is  only  present  in  50%  of  cases  and  absence  does  not  predict  hemorrhage  severity-  Consider  alveolar  hemorrhage  in  a  patient  with  GGOs  who  is  failing  to  progress  as  expected  (e.g.,  patient  with  suspected  cardiogenic  pulmonary  edema  who  is  not  improving  with  diuresis)Diagnostics:-  Labs:  CBC,  BUN/Cr,  UA,  ESR,  CRP.  Consider  rheumatologic  w/u,  which  may  include  ANA,  dsDNA,  RNP,  C3,  C4,  RF,  CCP,  ANCA,  MPO,  PR3,  cryoglobulins,  anti-GBM,  RVVT,  cardiolipin,  B2-glycoprotein  Ab-  Imaging:  Noncontrast  chest  CT  (consider  contrast  if  suspect  other  causes  of  hemoptysis):  Imaging  shows  patchy  or  diffuse  GGOs-  Bronchoscopy:  1)  Serial  lavage  –  gets  progressively  more  hemorrhagic;  2)  Rule  out  infection;  3)  Check  cell  count  with  differential  to  evaluate  for  eosinophiliaManagement:-  Capillaritis:  ImmunosuppressionFor  ANCA-associated  vasculitis,  typically  give  pulse-dose  steroids  first  and  then  adjunctive  therapies  like  cyclophosphamide,  rituximab,  etc.  if  lack  of  response-  Bland  hemorrhage  or  diffuse  alveolar  damage:Treat  underlying  cause,  supportive  care  
SN  - 
PB  - McGraw Hill
CY  - New York, NY
Y2  - 2024/04/20
UR  - accessmedicine.mhmedical.com/content.aspx?aid=1189912696
ER  -