Bronchoscopic Intrapulmonary Recombinant Factor VIIa for Diffuse Alveolar Hemorrhage-induced Acute Respiratory Failure in MPO-ANCA Vasculitis: A Case Report
Article Category: Case Report
Published Online: May 12, 2022
Page range: 123 - 125
Received: Jan 24, 2022
Accepted: Apr 04, 2022
DOI: https://doi.org/10.2478/jccm-2022-0004
Keywords
© 2022 Illaa Smesseim, Titia Schaepman-Ruys, Jan Willem Duitman, Yosta Vegting, Jorinde Raasveld, Marc Hilhorst, Alexander Vlaar, Josien van Es, Peter Bonta, published by Sciendo
This work is licensed under the Creative Commons Attribution 4.0 International License.
Introduction
Diffuse alveolar haemorrhage (DAH) is a potentially life-threatening disease, characterized by diffuse accumulation of red blood cells within the alveoli. It can be caused by a variety of disorders. In case DAH results in severe respiratory failure, veno-venous extracorporeal membrane oxygenation (VV-ECMO) can be required. Since VV-ECMO coincides with the need for anticoagulation therapy, this results in a major clinical challenge in DAH patients with hemoptysis.
Case presentation
We report a patient case with severe DAH-induced acute respiratory failure and hemoptysis in need for VV-ECMO complicated by life-threatening membrane oxygenator thrombosis. The DAH-induced hemoptysis was successfully treated with local bronchoscopic recombinant factor VIIa (rFVIIa), allowing systemic anticoagulation to prevent further membrane oxygenator thrombosis. Neither systemic clinical side effects nor differences in the serum coagulation markers occurred after applying recombinant factor VIIa (rFVIIa) treatment endobronchially.
Conclusion
This is, to our knowledge, the first case that reports the use of rFVIIa in a patient with DAH due to vasculitis and in need for VV-ECMO complicated by membrane oxygenator thrombosis.