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Diffuse alveolar haemorrhage: case report In a study of 1023 patients treated between January 2006 and December 2018, a 71-year-old woman was described, who developed diffuse alveolar haemorrhage (DAH) during treatment with heparin and unspecified tissue plasminogen activator gene therapy. The woman was hospitalised due to global aphasia and right hemiplegia. Her history was significant for atrial fibrillation and mitral stenosis. Considering an acute ischaemic stroke, she started receiving unspecified tissue plasminogen activator gene therapy [tissue-type plasminogen activator] followed by heparin [routes and dosages not stated]. After 8 hours of initiating unspecified tissue plasminogen activator gene therapy, she developed shortness of breath. Her haemoglobin dropped from 12.5 to 7.2 g/dL. There were bilateral rales and the oxygen saturation on room air was 88% [not all duration of treatments to reaction onsets stated]. The woman was treated with plasma [fresh frozen plasma] and RBCs. During investigations, a chest radiograph showed new bilateral alveolar infiltrates, although there was no evidence of pulmonary emboli. The bronchoalveolar lavage (BAL) fluid was bloody. Based on these findings and clinical presentation, she was diagnosed with DAH. For mechanical ventilation, she was put on endotracheal intubation. She was also started on extra-corporeal membrane oxygenation due to severe hypoxaemia and respiratory failure. However, she suddenly collapsed and despite performing percutaneous cardiopulmonary bypass, she died the same day [immediate cause of death not stated]. Thereafter, an autopsy studies revealed neutrophilic septal infiltrates and associated alveolar haemorrhage. Shimizu Y, et al. Risk factors of diffuse alveolar hemorrhage after acute ischemic stroke treated with tissue-type plasminogen activator. The effectiveness of activated recombinant factor VII treatment. Surgical Neurology International 11: No. 129, 2020. Available from: URL: http://doi.org/10.25259/SNI_2_2020 803497714

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Reactions 22 Aug 2020 No. 1818