A 39 year old woman, with a personal history of acute promyelocytic leukaemia treated with chemotherapy and renal failure with recent arteriovenous fistula intervention. The patient was admitted to the ICU with hypoxemic respiratory failure with cough and haemoptysis, requiring orotracheal intubation and mechanical ventilation. The thorax X-ray showed a "patchy" infiltrate affecting bases and middle fields. Values of haemoglobin with 11,4 decreased to 7,9 g/dl concomitant with reduced platelet count from 100 × 10[3]/μL to 40 × 10 [3] /μL during the first 24 hours. Suddenly, the patient deteriorated with an abrupt desaturation and frank haemoptysis through the orotracheal tube. In order to achieve platelet readings of over 50,000/μL a transfusion of 8 units of platelets was necessary before the drug could be administered. An emergency fibrobronchoscopy confirmed DAH. Systemic administration of rFVIIa was considered, but the potential thrombogenic effect of the drug and the risk of obstruction of the recent arteriovenous fistula prompted us to decide to administer 50 μg/Kg of rFVIIa in 50 ml of isotonic saline via the bronchoscopy channel, 25 ml in each main bronchus; following this, immediate cessation of bleeding was observed. Prior to this, the families had been informed and their written consent obtained.