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Diffuse alveolar haemorrhage — SCE Acute Medicine MCQ

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HardAcute Respiratory PresentationsDiffuse alveolar haemorrhageSCE Acute Medicine

A 46-year-old woman presents with haemoptysis, breathlessness and dark urine. Oxygen saturation is 88% on air and chest radiograph shows bilateral alveolar shadowing. Creatinine has risen from 78 to 214 micromol/L, urine dipstick shows blood and protein, and haemoglobin has fallen by 22 g/L over 24 hours. What is the most appropriate investigation?

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Correct answer: C — Urgent ANCA and anti-GBM testing with renal assessment

Pulmonary haemorrhage with rapidly progressive renal impairment suggests pulmonary-renal syndrome from ANCA-associated vasculitis or anti-GBM disease. Urgent serology and renal involvement are needed because immunosuppression and plasma exchange decisions may be time-critical. D-dimer is not the correct discriminator in this multisystem presentation. The pearl is that haemoptysis plus nephritic urine is pulmonary-renal syndrome until proved otherwise.

Reference: https://www.nice.org.uk/guidance#acute-medicine-order-80-1