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

John Selickman; Jacob Fiocchi; Hem Desai; Kathryn M Pendleton

doi:10.1016/j.rmcr.2022.101742

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

Respir Med Case Rep. 2022 Sep 16:39:101742. doi: 10.1016/j.rmcr.2022.101742. eCollection 2022.

Authors

John Selickman¹, Jacob Fiocchi², Hem Desai¹, Kathryn M Pendleton¹

Affiliations

¹ Department of Medicine, Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, University of Minnesota, Minneapolis, MN, USA.
² Department of Medicine, Division of General Internal Medicine, University of Minnesota, Minneapolis, MN, USA.

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.

Publication types

Case Reports