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Lung India. 2019 Nov-Dec;36(6):534-539. doi: 10.4103/lungindia.lungindia_8_19.

Warfarin-induced diffuse alveolar hemorrhage: Case report and a review of the literature.

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Department of Cardiology, Sawai Man Singh Medical College, Jaipur, Rajasthan, India.
Department of Chest and Tuberculosis, Sawai Man Singh Medical College, Jaipur, Rajasthan, India.


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.


Bronchoscopic alveolar lavage; computed tomography of the chest; diffuse alveolar hemorrhage; fiber-optic bronchoscopy; warfarin

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