Extracorporeal Membrane Oxygenation for Diffuse Alveolar Hemorrhage Caused by Idiopathic Pulmonary Hemosiderosis: A Case Report and a Review of the Literature

AbstractDiffuse alveolar hemorrhage (DAH) is a life-threatening condition presenting with hemoptysis, anemia, and diffuse radiographic pulmonary infiltrates; it causes acute respiratory failure. Idiopathic pulmonary hemosiderosis (IPH) is a rare cause of DAH occurring predominantly in children. Bleeding is often considered to be a contraindication for extracorporeal membrane oxygenation (ECMO) due to systemic anticoagulation. We present an 8-year-old girl with DAH caused by IPH. Unfractionated heparin was administered to maintain an activated clotting time of 150 to 180 seconds. The DAH resolved with immunosuppressive therapy, and the patient survived to decannulation. ECMO may be applied as a rescue therapy for DAH even with systemic anticoagulation.

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Successful management of warfarin-exacerbated diffuse alveolar hemorrhage using an extracorporeal membrane oxygenation

Multidisciplinary Respiratory Medicine ◽

10.4081/mrm.2013.490 ◽

2013 ◽

Vol 8 ◽

Author(s):

Jong Hoo Lee ◽

Su Wan Kim

Keyword(s):

Extracorporeal Membrane Oxygenation ◽

Warfarin Therapy ◽

Ventilatory Support ◽

Diffuse Alveolar Hemorrhage ◽

Alveolar Hemorrhage ◽

Vein Thrombosis ◽

Membrane Oxygenation ◽

Threatening Condition ◽

Life Threatening ◽

Chest X Ray

Although diffuse alveolar hemorrhage complicating warfarin therapy is rare, it generally has a worsening clinical course and can be a life threatening condition. A 56-year-old male who had undergone a pulmonary lobectomy for lung cancer 2 years before had received warfarin for about 5 months due to pulmonary vein thrombosis. The patient presented with severe dyspnea and had prolonged anticoagulation values. Chest X-ray and computed tomography revealed diffuse pulmonary consolidations, and bronchoalveolar lavage demonstrated diffuse alveolar hemorrhage. The reversal of anticoagulation was initiated, and extracorporeal membrane oxygenation was performed for refractory respiratory failure that did not improve despite maximal mechanical ventilatory support. The diffuse alveolar infiltrations resolved after 5 days, and we successfully weaned off both extracorporeal membrane oxygenation and mechanical ventilation. Herein we report the detailed course of a case that was successfully treated with extracorporeal membrane oxygenation as a bridge-to-recovery for warfarin- exacerbated diffuse alveolar hemorrhage.

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Severe Alveolar Hemorrhage – What’s in it for the Gastroenterologist?

Journal of Gastrointestinal and Liver Diseases ◽

10.15403/jgld.2014.1121.254.cut ◽

2016 ◽

Vol 25 (4) ◽

pp. 555-558

Author(s):

Alina Popp

Keyword(s):

Celiac Disease ◽

International Normalized Ratio ◽

Gluten Free Diet ◽

Alveolar Hemorrhage ◽

Severe Anemia ◽

Gluten Free ◽

Pulmonary Infiltrates ◽

Pulmonary Hemosiderosis ◽

Threatening Condition ◽

Life Threatening

Background: Alveolar hemorrhage is a potentially life-threatening condition which is usually managed by the pulmonologist. When considering its etiology, there is a rare association that sets the disease into the hands of the gastroenterologist. Case presentation: We report the case of a 48 year-old female who was admitted to the intensive care unit for severe anemia and hemoptysis. On imaging, diffuse pulmonary infiltrates suggestive of alveolar hemorrhage were detected and a diagnosis of pulmonary hemosiderosis was made. She received cortisone therapy and hematologic correction of anemia, with slow recovery. In search of an etiology for the pulmonary hemosiderosis, an extensive workup was done, and celiac disease specific serology was found positive. After confirmation of celiac disease by biopsy, a diagnosis of Lane-Hamilton syndrome was established. The patient was recommended a gluten-free diet and at 6 months follow-up, resolution of anemia and pulmonary infiltrates were observed. Conclusion: Although the association is rare, celiac disease should be considered in a patient with idiopathic pulmonary hemosiderosis. In our case, severe anemia and alveolar infiltrates markedly improved with glucocorticoids and gluten-free diet. Abbreviations: APTT: activated partial thromboplastin time; BAL: bronchoalveolar lavage; CD: celiac disease; Cd: crypt depth; GFD: gluten-free diet; GI: gastrointestinal; IEL: intraepithelial lymphocyte; INR: international normalized ratio; IPH: idiopathic pu

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Differentiation of idiopathic pulmonary hemosiderosis from rheumatologic and autoimmune diseases causing diffuse alveolar hemorrhage: establishing a diagnostic approach

Clinical Rheumatology ◽

10.1007/s10067-021-05895-1 ◽

2021 ◽

Author(s):

Biplab K. Saha ◽

Woon H. Chong ◽

Nils T. Milman

Keyword(s):

Autoimmune Diseases ◽

Diffuse Alveolar Hemorrhage ◽

Diagnostic Approach ◽

Alveolar Hemorrhage ◽

Pulmonary Hemosiderosis ◽

Idiopathic Pulmonary Hemosiderosis

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Extracorporeal membrane oxygenation (ECMO) for COVID-19 patients

Clinical Critical Care ◽

10.54205/ccc.v29i.252413 ◽

2021 ◽

Author(s):

Surat Tongyoo ◽

Suneerat Kongsayreepong

Keyword(s):

Extracorporeal Membrane Oxygenation ◽

Ecmo Support ◽

Janus Kinase ◽

Systemic Steroid ◽

Heparin Infusion ◽

Membrane Oxygenation ◽

Rescue Treatment ◽

Threatening Condition ◽

Life Threatening ◽

The Individual

During the current outbreak of coronavirus disease 2019 (COVID-19), Extracorporeal Membrane Oxygenation (ECMO) support could be considered as the rescue treatment from life threatening condition among severe COVID-19 patients who did not respond to mechanical ventilation. We propose that veno-venous ECMO should be considered if patient has persistence PaO2:FiO2 ratio lower than 100 mmHg after appropriate mechanical ventilator adjustment, muscle relaxant and prone position. During ECMO support, treatment against cytokine storm, including non-selective immune suppression with systemic steroid, or selective interleukin-6 inhibition and Janus Kinase inhibition should be considered. Heparin infusion is still the recommended anticoagulant to maintain activated partial thromboplastin time (APTT) ratio range 1.5-2.0. The overall hospital mortality was comparable with respiratory failure patients, requiring ECMO support from other causes, which was reported about 37-50%. The decision to initiate ECMO could be depended on the individual hospital capacity and treatment availability.

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An uncommon cause of diffuse alveolar hemorrhage in a young male

Monaldi Archives for Chest Disease ◽

10.4081/monaldi.2019.1067 ◽

2019 ◽

Vol 89 (2) ◽

Author(s):

Anshul Mittal ◽

Jagdish Chander Suri ◽

Shibdas Chakrabarti ◽

Pranav Ish

Keyword(s):

Systemic Lupus Erythematosus ◽

Lupus Nephritis ◽

Lupus Erythematosus ◽

Renal Involvement ◽

Young Male ◽

Diffuse Alveolar Hemorrhage ◽

Alveolar Hemorrhage ◽

Systemic Lupus ◽

Threatening Condition ◽

Life Threatening

It is uncommon for Systemic lupus erythematosus (SLE) to present with diffuse alveolar hemorrhage (DAH) as the initial presentation. To diagnose this in a young male with no renal involvement is further uncommon. We report a case of a 16-year-old boy, who presented with hemoptysis and was eventually diagnosed as DAH with underlying SLE. Treatment with steroids and immunosuppressant helped in rapid recovery from this potentially life-threatening condition. This case highlights the need of defining diagnostic criteria for SLE in patients presenting as DAH and formulating guidelines for treatment of the same, especially in absence of co-existing lupus nephritis.

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AUTOIMMUNE DIFFUSE ALVEOLAR HEMORRHAGE TREATED WITH CYCLOPHOSPHAMIDE WHILE ON EXTRACORPOREAL MEMBRANE OXYGENATION

CHEST Journal ◽

10.1016/j.chest.2020.08.692 ◽

2020 ◽

Vol 158 (4) ◽

pp. A738-A739

Author(s):

Ramni Khattar ◽

Muhammad Siddiqui ◽

Anne Bostwick ◽

Trenton Wray ◽

Jon Marinaro ◽

...

Keyword(s):

Extracorporeal Membrane Oxygenation ◽

Diffuse Alveolar Hemorrhage ◽

Alveolar Hemorrhage ◽

Membrane Oxygenation

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Extracorporeal Membrane Oxygenation for Severe ARDS Due to Immune Diffuse Alveolar Hemorrhage

CHEST Journal ◽

10.1016/j.chest.2019.10.021 ◽

2020 ◽

Vol 157 (3) ◽

pp. 744-747 ◽

Cited By ~ 1

Author(s):

Benjamin Seeliger ◽

Klaus Stahl ◽

Heiko Schenk ◽

Julius J. Schmidt ◽

Olaf Wiesner ◽

...

Keyword(s):

Extracorporeal Membrane Oxygenation ◽

Diffuse Alveolar Hemorrhage ◽

Alveolar Hemorrhage ◽

Membrane Oxygenation

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Respiratory Syncytial Virus Associated Myocarditis Requiring Venoarterial Extracorporeal Membrane Oxygenation

Case Reports in Infectious Diseases ◽

10.1155/2017/7074508 ◽

2017 ◽

Vol 2017 ◽

pp. 1-4 ◽

Cited By ~ 2

Author(s):

Anamaria Milas ◽

Aditya Shah ◽

Neesha Anand ◽

Meghan Saunders-Kurban ◽

Samir Patel

Keyword(s):

Respiratory Syncytial Virus ◽

Extracorporeal Membrane Oxygenation ◽

Fulminant Myocarditis ◽

Membrane Oxygenation ◽

Venoarterial Extracorporeal Membrane Oxygenation ◽

Threatening Condition ◽

Life Threatening ◽

Rsv Infection ◽

Syncytial Virus ◽

Va Ecmo

Severe fulminant myocarditis causing cardiogenic shock can be a rapidly progressing, life threatening condition. Respiratory syncytial virus (RSV) is a very rare infectious culprit infrequently described in medical literature as a cause of myocarditis, particularly in adults. We present a case of acute fulminant myocarditis in a patient with PCR positive RSV infection requiring venoarterial extracorporeal membrane oxygenation (VA-ECMO).

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