Pulmonary haemorrhage

Bucknall CE, Adamson MR, Banham SW. Non fatal pulmonary haemorrhage associated with nitrofurantoin. Thorax 1987 42(6) 475-6. 

Pulmonary haemorrhage associated with haemolytic anaemia has been reported in four men exposed to very high concentrations of heated trimellitic anhydride fumes (Zeiss and Patterson, 1993). Increased total antibody levels were found in these men. Using a rat model it has been shown that there was a linear relationship between antibody concentrations and the degree of pulmonary haemorrhage suggesting that immune mechanisms may play a role in this disorder (Zeiss and Patterson, 1993). 

Goodpasture disease/syndrome. An autoimmune pulmonary-renal syndrome characterized by pulmonary haemorrhage, glomerulonephritis, and production of autoantibody to glomerular... 

However, a patient taking acenocoumarol developed a pulmonary haemorrhage associated with a very prolonged prothrombin time within 10 days of starting to take diclofenac. Another report mentions a Chinese patient taking warfarin who developed an INR of 4 within 4 days of using a 1% diclofenac topical gel for joint pain. ... 

Limited evidence su ests that the combined use of intravenous high-dose epoprostenol and warfarin may increase the risk of pulmonary haemorrhage. Continuous subcutaneous treprostinil did not alter the pharmacokinetics or the INR in response to singledose warfarin, and also did not appear to increase the risk of bleeding when used with warfarin in clinical studies. Because these prostaglandins inhibit platelet a regation, some caution is appropriate on combined use with anticoagulants. 

Rubin AS, Hochhegger B, Irion KL, Marchiori E, Binukrishnan SR, Moreira JS, Zanetti G. Ketorolac tromethamine associated with diffuse pulmonary haemorrhage high-resolution CT findings. Br J Radiol 2010 83(991) el58-60. 

Intramacrophagic iron was 0.33 0.21 pgxl0 cells in healthy non-smoking subjects without occupational exposure (Corhay et al. 1992). Intramacrophagic iron was increased in smokers, iron-steelworkers, and in patients with chronic obstructive pulmonary disease or lung cancer even in the absence of pulmonary haemorrhage. About 80 % of the whole bronchoalveolar lavage fluid iron content was in the cells. 

McDougall RJ, Sherrington CA (1999) Fatal pulmonary haemorrhage during anaesthesia for bronchial artery embo-Uzation in cystic fibrosis. Paediatr Anaesth 9345-348... 

El-Mistiy N, Pusey CD, Gaskin G. Markers of pulmonary haemorrhage in microscopic polyangiitis. Sarcoidosis Vase Diffuse Lung Dis 1996 13 268. 

Al Riyami BM, Al Kaabi JK, Elagib EM, et al. Subclinical pulmonary haemorrhage causing a restrictive lung defect in three siblings with a unique urticarial vasculitis syndrome. Clin Rheumatol 2003 22 309-313. 

The alveolar proteinosis caused by heavy exposure to silica ( acute silico-proteinosis ) and possibly by other agents (Blanc 1992) would qualify for this entity. Similarly, some instances of exogenous lipoid pneumonitis seem to correspond well to the concept of subacute toxic pneumonitis. The pulmonary haemorrhagic syndrome associated with exposure to trimellitic anhydride and, possibly, to methylene diphenyl diisocyanate is also a potential form of toxic response but, in this instance, the role of specific immunological mechanisms is likely. 

Pulmonary haemorrhage results in perfusion-ventilation mismatch and reduced compliance, leading to increased work of breathing and progressive hypoxia. Apnoea can also occur as part of the reflex triad of apnoea, bradycardia and hypotension as a consequence of blast exposure (see above). 

FFP) should be used for the DIC. There is now evidence that recombinant factor Vila may be of value in life-threatening pulmonary haemorrhage. Early recognition of a significantly reduced potassium followed by intravenous replacement may reduce the likelihood of arrh5rthmias. 

Massive pulmonary haemorrhage may cause death either as a result of upper-airway obstruction or due to effective cessation of gas exchange in blood-fill alveoli. Sudden death following blast exposure has also been ascribed to concealed (internal) haemorrhage from organ damage. 

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