DAH

Q: In diffuse Alveolar Hemorrhage (DAH), What's the maximum dose of glucocorticoids that can be used? 


Answer: 2000 mg

In patients with DAH due to capillaritis, including systemic vasculitis, anti-glomerular basement membrane [GBM] syndrome, or rheumatic disease), despite no strong evidence a mega-dose of steroid has been a standard of care. Dose anywhere from 500 to 2000 mg daily in divided doses can be used. A high steroid dose is usually given as a course of 5 days and is recommended to a transition to oral agents, followed by tapering to a targeted maintenance dose.

As the role and dose of steroid in DAH are not established, some experts even suggested low dose steroid, to avoid the outfall from medium or high dose steroids 3.

#pulmonary


References:

1. Jennings CA, King TE Jr, Tuder R, et al. Diffuse alveolar hemorrhage with underlying isolated, pauciimmune pulmonary capillaritis. Am J Respir Crit Care Med 1997; 155:1101. 

2. Schwarz MI, Brown KK. Small vessel vasculitis of the lung. Thorax 2000; 55:502.

3.  NK Rathi et al. Low-, medium- and high-dose steroids with or without aminocaproic acid in adult hematopoietic SCT patients with diffuse alveolar hemorrhage. Bone Marrow Transplantation (2015) 50, 420–426