Diffuse alveolar hemorrhage


  • Diffuse Alveolar Hemorrhage (DAH) is a life-threatening condition
  • It is a subset of Pulmonary hemorrhage involving the microcirculation involving alveolar microvasculature
  • Most commonly the result of systemic vasculitis [1]

Clinical Features

  • Hemoptysis ( may be initially absent in up 33% of DAH presentations [2]
  • Anemia
  • Diffuse lung infiltrates
  • Acute hypoxemic respiratory failure

Differential Diagnosis


  • Clinical suspicion with falling hematocrit
  • Radiographic imaging consistent with bilateral infiltration (CXR, CT) - can be patchy, focal or diffuse
  • Bronchoscopy with BAL showing sequentially increasing RBC counts


  • Airway stabilization if large volume hemoptysis or problems with oxygenation/ventilation (>8.0 ETT preferable)
  • IV corticosteroids - high dose Methylprednisolone Q6H[3]
  • Bronchoscopy to obtain BAL and localize/address source of bleeding if localizable
  • Management of Hemoptysis
    • Correct any coagulopathy
    • Consider nebulized TXA if massive[4]


  • Typically requires upper level of care

See Also

Life in the Fast Lane: Diffuse Alveolar Hemorrhage


  1. Park M. Diffuse Alveolar Hemorrhage. Tuberc Resp Dis (Seoul) 2013. 74(4):151-162
  2. Lara A, Schwarz M. Diffuse Alveolar Hemorrhage. Chest 2010. 137(5):1164-1171
  3. Park M. Diffuse Alveolar Hemorrhage. Tuberc Resp Dis (Seoul) 2013. 74(4):151-162
  4. Wand O, et al. Inhaled Tranexamic Acid for Hemoptysis Treatment: A Randomized Controlled Trial. Chest. DOI: https://doi.org/10.1016/j.chest.2018.09.026
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