Vasculitis/Diffuse Alveolar Hemorrhage - Diagnosis
DIAGNOSIS
SYMPTOMS
- Highly variable1
- Patients commonly present with nonspecific symptoms that can develop acutely or over time1,2
- Dyspnea
- Cough
- Fever
- Chest pain
- A majority of patients (~67%) experience a variable degree of hemoptysis1
- Anemia — acute or chronic (lasting several weeks) — is common2
- Patients will often have signs and symptoms of a related systemic disorder1
- Patient presentation can range from being asymptomatic with radiographic abnormalities to severe respiratory failure resulting from impaired oxygen uptake from the alveoli1,2
DIAGNOSTICS
- Decreased hemoglobin and/or hematocrit levels without external bleeding in addition to increasing pulmonary alveolar opacities is characteristic of DAH2
- Identification of the underlying systemic disease causing DAH is crucial1
- Review of systems including exposure history
- Past medical history
- Comprehensive physical exam
DIAGNOSIS OF DAH
Transbronchial Lung Biopsy
- Diagnostic gold standard to show alveolar hemorrhage as well as the inflamed capillaries2
- Histologic confirmation of vascular inflammation is required1
Imaging – Chest X-ray (CXR) and High-Resolution Computed Tomography (HRCT):
- Nonspecific, varies through disease course1,2
- Alveolar opacities - focal or diffuse areas of ground glass and/or consolidation1,2
- Opacities are bilateral, patchy or diffuse, dominant in mid and lower zones of the lungs2
- Pleural effusion is not a feature of DAH; if present, suspect heart or renal failure2
Bronchoscopy with Bronchoalveolar Lavage (BAL):
- Frequently required to accurately diagnose DAH1
- Confirms presence of blood in the alveoli and rules out infection1
Laboratory studies:
- Because of nonspecific presentation, comprehensive panels should be done including complete blood count (CBC), coagulation, serum creatinine, and antineutrophil cytoplasmic antibody (ANCA) testing1
