Clinical Analysis Of 10 Patients With Diffuse Alveolar Hemorrhage

Objetive To improve the recognition of diffuse alveolar hemorrhage(DAH) so as to diagnose DAH early and improve its prognosis.Methods To analyze retrospectively the datas of clinical Presentation, auxiliary examination, diagnosis and treatment in 10 cases of DAH in the second affiliated hospital of fujian medical university from November 2009 to May 2014.Results In the 10 cases, Systemic lupus erythematosus(SLE) accounted for 5 cases,anti-neutrophil cytoplasmic antibody(ANCA)-associated vasculitis(AAV) for 4 cases and Scleroderma for 1 case. Clinical presentations included dyspnea(8/10), hemoptysis(5/10), bloody sputum(5/10). Hypoxaemia occurred in 60%(6/10).Anaemia occurred in 90%(9/10) and the drop in hemoglobin within 24-48 hours was more than 15 g/l which occurred in 70%(7/10).All patients had radiographic infiltrates and the distributions were 70% in all lung fields. The radiographic patterns consisted of ground-glass opacities, consolidations, masses and reticular interstitial opacities.5 cases performed bronchoscopy and bronchoalveolar lavage( BAL). Bronchoalveolar lavage fluid presented with blood accounted for 4 cases. Hemosiderin-laden macrophages were found in one case that performed transbronchial lung biopsy(TBLB). 2 cases required mechanical ventilation,a total of 9 patients were treated with glucocorticoid, and 5 cases with hormone shock therapy,6 cases with cyclophosphamide,5 cases with plasmapheresis,5 cases with immuneglobulin,2 cases with mycophenolate mofetil,1 case with immunoadsorption.9 patients improved without cough, dyspnea or hemoptysis,1case died for giving up further treatments.Conclusions 1.AAV and autoimmune diseases especially the SLE are the common causes of DAH. 2. DAH should be considered when patients present with unexplained drop in hemoglobin, bilateral ground-glass opacities、consolidations and masses on thethoracic imaging, even if without haemoptysis or dyspnea. Bronchoscopy and bronchoalveolar lavage to look for blood and/or hemosiderin-laden macrophages are often used in the diagnosis of DAH. 3.The combination of glucocorticoid, immunosuppressant, plasmapheresis and immunoglobulin has proven an effective method in the treatment of DAH.