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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Bibliographic Details
Published in:Lung India 2019-11, Vol.36 (6), p.534-539
Main Authors: Kunal, Shekhar, Bagarhatta, Rajeev, Singh, Sheetu, Sharma, Sohan
Format: Article
Language:English
Subjects:
Adult respiratory distress syndrome
Anticoagulants
bronchoscopic alveolar lavage
Case Report
Case reports
Cellular biology
computed tomography of the chest
diffuse alveolar hemorrhage
Dyspnea
fiber-optic bronchoscopy
Heart failure
Hemoptysis
Hemorrhage
Mortality
Patients
Pulmonary arteries
Respiratory failure
Respiratory insufficiency
Strategic planning (Business)
Tomography
Warfarin
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Summary: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.
ISSN:0970-2113
0974-598X
DOI:10.4103/lungindia.lungindia_8_19