Diffuse Alveolar Hemorrhage

Diffuse alveolar hemorrhage (DAH) is when there’s bleeding in the small air sacs in your lungs (alveoli). The bleeding is widespread (diffuse) in your lungs’ tissues.

DAH happens when there’s damage or inflammation in the blood vessels in your lungs. It can feel hard to breathe as your alveoli fill with blood.

Diffuse alveolar hemorrhage can be fatal. Call 911 or go to the emergency room if you have shortness of breath or chest pain, or you’re coughing up blood.

Symptoms of diffuse alveolar hemorrhage

DAH symptoms include:

• Shortness of breath
• Chest pain
• Fever
• Cough
• Coughing up blood

You might also have symptoms of the underlying condition that’s causing the bleeding. These could include rash, muscle pain or joint pain.

Diffuse alveolar hemorrhage causes

Inflammation or damage to the blood vessels in your lungs causes DAH. There are many different causes that can lead to this damage, including:

• Acute respiratory distress syndrome (ARDS)
• Bone marrow transplant
• Blood clots in your lungs (pulmonary embolism)
• Certain autoimmune diseases, most commonly vasculitis, lupus (SLE) and Goodpasture syndrome
• Certain medications, like blood thinners, cancer chemotherapy, amiodarone, nitrofurantoin, penicillamine and sirolimus
• Conditions that affect your heart
• Idiopathic pulmonary hemosiderosis, a condition that causes bleeding in your lungs
• Infections
• Inflammation in your blood vessels (capillaritis)
• Inflammation in your kidneys (glomerulonephritis)
• Inhaling cocaine
• Tumors
• Radiation treatment

Risk factors

You're at an increased risk if you have any of the conditions that can cause DAH or you have a weakened immune system.

Complications

If blood fills the sacs in your lungs that are meant for air, you won’t be able to breathe properly or get oxygen to the tissues in your body. This can lead to hypoxia and respiratory failure.

How doctors diagnose diffuse alveolar hemorrhage

Healthcare providers diagnose diffuse alveolar hemorrhage with bronchoalveolar lavage. This means washing and collecting fluid during a procedure that looks inside your lungs (bronchoscopy). If you have more than one sample of fluid with blood in it, your provider will diagnose DAH.

They may also use additional tests to determine the cause. These include:

• Blood tests
• Imaging
• Lung biopsy
• Kidney biopsy

How is diffuse alveolar hemorrhage treated?

Treatment for DAH varies widely based on the cause. You’ll likely have a care team that includes pulmonologists, rheumatologists, cardiologists and others.

If autoimmune disease is the cause, your provider may use IV corticosteroids. For other causes, they may also use:

• Cyclophosphamide and other immunosuppressant medications
• Plasmapheresis (plasma exchange)
• Intravenous immunoglobulin (IVIG)

If a medication is causing DAH, your provider might recommend stopping or changing your medication.

When should I seek care?

Call 911 or go to the emergency room if you’re having trouble breathing, you have chest pain or you’re coughing up blood. Diffuse alveolar hemorrhage and other conditions that cause these symptoms can be fatal.

What can I expect if I have diffuse alveolar hemorrhage?

Diffuse alveolar hemorrhage is an emergency. You’ll be treated in the hospital. New treatments are more effective at bringing down inflammation and stopping the bleeding. But it can still be fatal in many cases.

If an ongoing health condition caused DAH, it could happen again in the future.

Can this be prevented?

Managing any health conditions that can lead to bleeding in your lungs is the best way to prevent diffuse alveolar hemorrhage. Talk to your doctor about any concerns you have.