Successful hemostasis in refractory alveolar hemorrhage using low-dose recombinant activated factor VII

Abstract

Diffuse alveolar hemorrhage (DAH) is a life-threatening condition requiring prompt recognition. Conventional therapy, even when initiated early, may not have an immediate effect, and in severe cases, bleeding can persist despite treatment. We report the case of a previously healthy 33-year-old male who developed DAH secondary to granulomatosis with polyangiitis, resulting in respiratory failure and the need for mechanical ventilation. High-dose corticosteroids, plasma exchange, and remission induction with cyclophosphamide failed to control bleeding, leading to severely impaired gas exchange. 20 mcg/kg of systemic recombinant activated Factor VII (rFVIIa), a dose lower than previously reported for management of DAH, resulted in hemostasis and improved oxygenation after only three doses. No complications were observed, and our patient was liberated from ventilatory support eight days later. In the setting of DAH with refractory bleeding, hemostasis may be achievable with a lower dose of rFVIIa than commonly used, potentially mitigating the risk of dose-dependent side effects.

Keywords: 1; 2; 3; Diffuse alveolar hemorrhage; Granulomatosis with polyangiitis; Recombinant activated factor VII.

Fig. 1

Initial chest radiograph demonstrating the presence of mixed interstitial and airspace opacities in the left mid-lung and right upper lobe (left panel). Subsequent chest radiograph prior to intubation demonstrating interval worsening (right panel).

Fig. 2

Axial slice from computed tomography demonstrating consolidative opacities in the dependent portion of the upper lobes and adjacent areas of ground glass opacities.