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Warfarin-induced diffuse alveolar hemorrhage: Case report and a review of the literature

Diffuse alveolar hemorrhage (DAH) refers to the intra-alveolar accumulation of blood originating from the pulmonary microvasculature. This life-threatening condition is a medical emergency as patients often develop acute respiratory failure requiring invasive mechanical ventilation. This mandates fo...

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Autores principales: Kunal, Shekhar, Bagarhatta, Rajeev, Singh, Sheetu, Sharma, Sohan Kumar
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Wolters Kluwer - Medknow 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6852223/
https://www.ncbi.nlm.nih.gov/pubmed/31670302
http://dx.doi.org/10.4103/lungindia.lungindia_8_19
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author Kunal, Shekhar
Bagarhatta, Rajeev
Singh, Sheetu
Sharma, Sohan Kumar
author_facet Kunal, Shekhar
Bagarhatta, Rajeev
Singh, Sheetu
Sharma, Sohan Kumar
author_sort Kunal, Shekhar
collection PubMed
description Diffuse alveolar hemorrhage (DAH) refers to the intra-alveolar accumulation of blood originating from the pulmonary microvasculature. This life-threatening condition is a medical emergency as patients often develop acute respiratory failure requiring invasive mechanical ventilation. This mandates for an early diagnosis with prompt and aggressive management strategies. A host of clinical disorders are known to cause DAH; however, warfarin-induced alveolar hemorrhage is a distinct clinical rarity. A search of the literature reveals few reports documenting this entity. A 27-year-old male presented with complaints of recent-onset hemoptysis and dyspnea. One month back, he was diagnosed with lower-limb deep-venous thrombosis and pulmonary embolism. He had been taking oral anticoagulants irregularly since then without monitoring of prothrombin time. Chest radiograph, done on presentation, revealed bilateral upper-lobe infiltrates, whereas computed tomography of the chest was suggestive of bilateral upper-lobe ground-glass opacities. Serial bronchoscopic alveolar lavage yielded samples which became progressively bloodier, whereas cytological evaluation of the sample revealed numerous alveolar macrophages with intracytoplasmic hemosiderin. A diagnosis of DAH due to warfarin was made, and the patient was administered Vitamin K followed by infusion of fresh frozen plasma. There was a marked clinical recovery, and the patient has been asymptomatic since then.
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spelling pubmed-68522232019-12-05 Warfarin-induced diffuse alveolar hemorrhage: Case report and a review of the literature Kunal, Shekhar Bagarhatta, Rajeev Singh, Sheetu Sharma, Sohan Kumar Lung India Case Report Diffuse alveolar hemorrhage (DAH) refers to the intra-alveolar accumulation of blood originating from the pulmonary microvasculature. This life-threatening condition is a medical emergency as patients often develop acute respiratory failure requiring invasive mechanical ventilation. This mandates for an early diagnosis with prompt and aggressive management strategies. A host of clinical disorders are known to cause DAH; however, warfarin-induced alveolar hemorrhage is a distinct clinical rarity. A search of the literature reveals few reports documenting this entity. A 27-year-old male presented with complaints of recent-onset hemoptysis and dyspnea. One month back, he was diagnosed with lower-limb deep-venous thrombosis and pulmonary embolism. He had been taking oral anticoagulants irregularly since then without monitoring of prothrombin time. Chest radiograph, done on presentation, revealed bilateral upper-lobe infiltrates, whereas computed tomography of the chest was suggestive of bilateral upper-lobe ground-glass opacities. Serial bronchoscopic alveolar lavage yielded samples which became progressively bloodier, whereas cytological evaluation of the sample revealed numerous alveolar macrophages with intracytoplasmic hemosiderin. A diagnosis of DAH due to warfarin was made, and the patient was administered Vitamin K followed by infusion of fresh frozen plasma. There was a marked clinical recovery, and the patient has been asymptomatic since then. Wolters Kluwer - Medknow 2019 /pmc/articles/PMC6852223/ /pubmed/31670302 http://dx.doi.org/10.4103/lungindia.lungindia_8_19 Text en Copyright: © 2019 Indian Chest Society http://creativecommons.org/licenses/by-nc-sa/4.0 This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.
spellingShingle Case Report
Kunal, Shekhar
Bagarhatta, Rajeev
Singh, Sheetu
Sharma, Sohan Kumar
Warfarin-induced diffuse alveolar hemorrhage: Case report and a review of the literature
title Warfarin-induced diffuse alveolar hemorrhage: Case report and a review of the literature
title_full Warfarin-induced diffuse alveolar hemorrhage: Case report and a review of the literature
title_fullStr Warfarin-induced diffuse alveolar hemorrhage: Case report and a review of the literature
title_full_unstemmed Warfarin-induced diffuse alveolar hemorrhage: Case report and a review of the literature
title_short Warfarin-induced diffuse alveolar hemorrhage: Case report and a review of the literature
title_sort warfarin-induced diffuse alveolar hemorrhage: case report and a review of the literature
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6852223/
https://www.ncbi.nlm.nih.gov/pubmed/31670302
http://dx.doi.org/10.4103/lungindia.lungindia_8_19
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