SHM Converge Scientific Abstract ePoster Gallery-Diffuse Alveolar Hemorrhage, a Rare Presentation of Immune Thrombocytopenia Purpura

Pdf Summary

This case describes a 63-year-old woman with a history of immune thrombocytopenic purpura (ITP), splenectomy, pulmonary embolism, and asthma who presented with sudden shortness of breath, petechial rash, severe anemia, and critically low platelets. Chest CT showed diffuse bilateral airspace opacities initially concerning for pulmonary edema or pneumonia. She was admitted to the ICU and treated with antibiotics, diuretics, steroids, blood products, and later IVIG, but her platelet count remained dangerously low.<br /><br />As her condition worsened, she developed large-volume hemoptysis and increasing hypoxemia, raising concern for diffuse alveolar hemorrhage (DAH). Bronchoalveolar lavage confirmed DAH. Because she had no neurological findings, normal kidney function, and no schistocytes, thrombotic thrombocytopenic purpura was less likely, supporting refractory ITP as the underlying cause. Bone marrow biopsy showed hypercellular marrow with megakaryocyte hyperplasia, consistent with increased platelet production in response to thrombocytopenia.<br /><br />Due to failure of initial therapy, she was started on romiplostim and rituximab. Her platelet count improved, respiratory status stabilized, and she was eventually weaned off supplemental oxygen.<br /><br />The report emphasizes that DAH is a rare but life-threatening complication of ITP. It should be suspected in patients with hemoptysis, diffuse pulmonary infiltrates, anemia, and respiratory failure. Flexible bronchoscopy with bronchoalveolar lavage is the preferred diagnostic test. Early treatment with corticosteroids and IVIG is standard, while thrombopoietin receptor agonists and rituximab may be needed in refractory or severe cases. Awareness and rapid recognition are critical for survival.

Asset Subtitle

Safeera Javed

Meta Tag

Author List Safeera Javed

Category Clinical Vignettes

Concept Diffuse Alveolar Hemorrhage

Concept Immune Thrombocytopenia

Concept Hemoptysis

Concept Diffuse Infiltrates

Concept Anemia

Distinguished Non-Finalist

Presenter Organization Baylor College of Medicine

Presenting Author Safeera Javed

Track Adult

Keywords

immune thrombocytopenic purpura

diffuse alveolar hemorrhage

hemoptysis

thrombocytopenia

bronchoalveolar lavage

rituximab

romiplostim

splenectomy

respiratory failure

petechial rash

Diffuse Alveolar Hemorrhage

Immune Thrombocytopenia

Hemoptysis

Diffuse Infiltrates

Anemia