Clinical Features of Diffuse Alveolar Hemorrhage (DAH)

 

Synonym: acute hemorrhage pulmonary edema, hemorrhagic alveolitis

 

Risk factors:

(1) non-HLA identical transplant

(2) graft vs host disease (GVHD), Grade II to IV

 

Onset: first 12-13 weeks (3 months) after transplant

 

Clinical features:

(1) progressive dyspnea

(2) cough

(3) hypoxemia

(4) hemoptysis rare

(5) fever may be present or absent

 

Broncho-alveolar lavage shows progressively bloodier aliquots.

 

Imaging features:

(1) diffuse pulmonary infiltrates (central appearance may be noticed initially)

 

Findings on lung biopsy:

(1) diffuse alveolar damage with intra-alveolar hemorrhage

 

Exclusion: infection, especially fungal pneumonia

 

The condition has a high mortality despite aggressively management.