The Internet Book of Critical Care Podcast IBCC EP 59 Diffuse Alveolar Hemorrhage & Pulmonary Vasculitis
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Oct 10, 2019 Exploring the presentation and treatment of vasculitides associated with respiratory failure. Discussing diagnostic tests and lab workups, CT chest and bronchoscopy. Controversy over using Plexivics as treatment. Coagulation management and potential complications.
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ANCA Vasculitis Basics
- Pulmonary vasculitis in ICU often presents as ANCA vasculitis causing diffuse alveolar hemorrhage or renal failure.
- Granulomatosis with polyangiitis and microscopic polyangiitis manifest similarly and are treated similarly, so distinguishing them is not critical initially.
Diagnosing DAH Without Hemoptysis
- Consider diffuse alveolar hemorrhage even without hemoptysis in patients with unexplained hypoxemia and bilateral opacities.
- Use CT for better sensitivity and to exclude alternative diagnoses before further workup.
Comprehensive Vasculitis Workup
- Send a vasculitis panel including ANCAs, MPO, PR3, anti-GBM, ANA, complement levels, and other autoantibodies early.
- Include infectious workup with blood cultures and respiratory viral antigens in parallel.