Pulmonary embolism and diffuse alveolar bleeding: combination options and therapy features

Abstract

The analysis of the mechanisms of the formation of a rare clinical combination of pulmonary embolism (PE) and diffuse alveolar hemorrhage (DAH), which are complications of systemic vasculitis associated with antibodies to the cytoplasm of neutrophils (primarily granulomatosis with polyangiitis), systemic lupus erythematosus and secondary antiphlogistic syndrome primary antiphospholipid syndrome and Goodpastures syndrome. Taking into account the chronological sequence of the occurrence of PE and DAH, 3 variants of the onset of these potentially fatal additions to the underlying disease were considered: the anticipatory DAH development of PE, delayed from DAH PE and joint (within 24 hours) formation of PE and DAH. A review of single descriptions of such a combination of complications of granulomatosis with polyangiitis is carried out, criteria are indicated, a working classification of severity is given and, taking this into account, a modern program of therapy for DAH as an independent event and in combination with PE.

Keywords

• diffuse alveolar bleeding
• pulmonary embolism
• granulomatosis with polyangiitis
• capillaritis
• leukocytoclasis
• neutrophil recruitment
• immunosuppressive therapy
• exchange plasma transfusion
• plasmapheresis
• recombinant coagulation factor vii