Inclusion Criteria:  Age > 18 years old Have a diagnosed hematological malignancy Are actively receiving mechanical ventilation  Have evidence of pulmonary hemorrhage as defined by either  Persistently bloody secretions upon endotracheal tube suctioning, or Evidence of diffuse alveolar hemorrhage by bronchoscopic examination Signed informed consent by patient or if the subject lacks decision-making capacity, the subject's legally authorized representative  2.3.2 Exclusion Criteria  Patients excluded from participation in the study if any of the following criteria are met:  Presence of a Do Not Resuscitate (DNR), no escalation of care or comfort care order at the time of screening Expected survival < 48 hours Evidence of nasal or oral spillage likely to be the cause of bloody secretions Patients requiring 100% FIO2 Known hypersensitivity to tranexamic acid Treatment with inhaled tranexamic acid prior to screening Acquired defective color vision Subarachnoid hemorrhage Deep Venous or arterial thrombus diagnosed within the previous 3 months Seizure disorder on active anti-epileptic therapies Hypersensitivity to tranexamic acid or any of the ingredients Pregnant women will not be eligible and have a negative pregnancy test prior to entering study Patient receiving concurrent anti-fibrinolytic therapy Confirmed active COVID-19 infection