Twenty cases of diffuse alveolar hemorrhage: A single center retrospective study

Na, Joo Ock; Kim, Soon Jong; Shim, Tae Sun; Lim, Chae Man; Lee, Sang Do; Kim, Woo Sung; Kim, Dong Soon; Kim, Won Dong; Koh, Younsuck

Abstract

BACKGROUND
Diffuse alveolar hemorrhage (DAH) is an uncommon pulmonary disease. It could be occurred by diverse causes with the different response to the treatment. However, the clinical features of DAH have not been well known in Korea.
METHODS
Twenty cases identified as DAH between March of 1990 and July of 2000 at a university affiliated hospital were retrospectively reviewed.
RESULTS
The median age was 45 yr (range: 18~73 yr) with 11 females. Diagnosis was made by clinical and radiologic findings including hemoptysis, newly developed anemia, and diffuse bilateral lung opacities with the continuous bloody lavage fluid or bloody bronchial aspirate on bronchoscopy. The mean APACHE III score was 50.8 (+/-26.7) points. Hemoptysis prior to admission was observed in 8 (40%) patients. Diffuse crackles were heard on the bilateral lung fields in 18 cases. On chest radiographs, diffuse ground glass appearance and/or confluent air space consolidation with ill defined irregular margin were mainly observed. In patients with DAH the hemoglobin level fell a mean of 2.0 (+/-0.8) g/dL. Fourteen (70%) patients received mechanical ventilation due to the respiratory failure. Six patients (30%) were dead during admission. Among these patients, 4 patients were dead due to refractory respiratory failure with continuous DAH. The bleeding tendency such as disseminated intravascular coagulation or low platelet count was higher in dead patients than the survivors (p=0.018). The survivors of DAH with noninfectious causes showed better responses to immunosuppressive drugs with/without plasmapheresis compared to nonsurvivors (p=0.003).
CONCLUSION
DAH was prone to develop acute respiratory failure and needed mechanical ventilation frequently. However, DAH of non-infectious causes showing a good response to the immunosuppresive therapy would have a better prognosis. In addition, DAH would have a worse prognosis in cases of combined bleeding tendency.