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Pulmonary Haemorrhage
Related Subjects: Granulomatosis with Polyangiitis GPA (Wegener's) |Goodpasture's syndrome (Anti GBM disease) |Respiratory Failure |Acute Kidney Injury |
🧬 Aetiology
- ANCA-associated vasculitis (e.g. granulomatosis with polyangiitis, microscopic polyangiitis).
- Anti-GBM disease (Goodpasture’s syndrome).
- Other causes (less common): lupus pneumonitis, coagulopathy, infections (e.g. TB), drugs (anticoagulants, cocaine).
🩺 Clinical Features
- Dyspnoea and cough with haemoptysis (can be life-threatening if massive).
- Fever, malaise, weight loss (systemic features of vasculitis).
- Oliguria or haematuria if renal involvement (pulmonary–renal syndrome).
- Signs of hypoxia, tachypnoea, and anaemia from blood loss.
🔎 Investigations
- PFT: Raised KCO (carbon monoxide transfer factor) – due to binding of CO to intra-alveolar blood, giving a false elevation.
- CXR: Patchy alveolar shadowing (air-space opacities) – may mimic pneumonia or pulmonary oedema.
- CT chest: better delineates diffuse alveolar haemorrhage.
- Bloods: FBC (anaemia), U&E, CRP/ESR, ANCA, anti-GBM antibodies.
- Bronchoscopy with lavage: helps confirm alveolar haemorrhage and exclude infection.
💊 Management
- 🚨 Urgent referral to Nephrology & ITU.
- High-flow O₂ ± ventilatory support for respiratory failure.
- Immunosuppression: IV methylprednisolone, cyclophosphamide or rituximab.
- Plasma exchange (plasmapheresis) – especially in anti-GBM disease.
- Treat underlying cause (e.g. stop anticoagulants, treat infection).
📚 References
| The content on this website is provided for educational and informational purposes only to support exam preparation (e.g., MLA, MRCP, USMLE) and learning. This is NOT medical advice, diagnosis, treatment, or professional guidance. It does not replace consultation with a qualified healthcare professional, official guidelines (e.g., NICE, GMC, BNF), or supervised clinical practice. Always verify information with current, authoritative sources. Makindo and its contributors accept no liability for any reliance on this content, including errors, omissions, or any resulting harm, loss, or consequences. By using this site, you agree to these terms. |
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