Coughing up blood
Coughing up blood (also called hemoptysis in medical parlance) is a very scary symptom.
Coughing up blood is common and can have many causes. Most causes are not serious. However, patients
may need to visit an ER immediately if they are coughing up large amounts of blood.
Blood that a person coughs up often looks bubbly or frothy and is mixed with mucus or spit. It can appear pink,
red or rust-colored and is usually in small amounts.
Is it serious?
It can be and therefore most patients will need evaluation to find out the cause.
What are the causes that can coughing up of blood?
Causes can range from mild (most common) to serious and potentially life-threatening. Usually,
coughing up blood is related to an infection. The most common causes include:
- Bronchitis.
- Pneumonia.
- Tuberculosis.
Other causes include:
- Bronchiectasis.
- Auto immune diseases of the lung and its arteries.
- Congestive heart failure.
- Injury to the arteries in the lungs.
- Using blood thinners (anticoagulants).
- Blood clot in the lung (pulmonary embolism).
- Chronic obstructive pulmonary disease (COPD).
- Lung cancer (especially in people over 40 who smoke).
- Blood entering your throat from your nose (nosebleed), tonsils or teeth.
Because one cannot be sure of the cause, it‘s better to go to a doctor if the symptom occurs more than once or there is a large amount of bleeding.
The doctor will review the medical history, perform a physical exam and ask questions to determine the cause.He may also ask about behaviors that put patients at risk, like drug use or smoking. He may try to identify potential causes by asking about other symptoms patients have been experiencing.
Doctors will perform any of the following tests to diagnose the underlying cause:
- A chest X-ray to look for tumors or fluid in the lungs.
- A computed tomography (CT) scan of the chest to investigate findings from the X-ray or accompany an additional procedure, like a bronchoscopy.
- A bronchoscopy to check if the airways are clear and locate the site where the bleeding’s occurring.
- A complete blood count (CBC) to assess how much blood has been lost and look for signs of infection.
- A sputum culture of lung excretions to look for infectious causes that may be causing the bleeding, like bacteria or viruses.
- A blood clotting test (coagulation test) to see if a bleeding disorder is related to the symptoms.
- Pulmonary arteriography to see how blood flows through the lungs.
- A urinalysis and/or kidney function test to rule out autoimmune conditions that affect lungs and kidneys.
Doctors may perform additional procedures or order other tests depending on what they suspect.
How is coughing up blood treated?
Treatment depends on how serious the blood loss is and what’s causing it.
If there is severe blood loss, patients will receive care in the intensive care unit (ICU) where they will be stabilized and attempts made to stop the bleeding before proceeding to diagnostic tests.
Treatments for severe blood loss related to coughing up blood may include:
- A bronchoscopy to remove clots in their airways that may be causing the bleeding.
- Bronchial artery angiography and embolization to stop blood flow in blood vessels that are causing the bleeding.
- Medicine that’s used to stop bleeding related to severe blood loss (tranexamic acid).
Once the cause is found the doctors will discuss the best treatment plan to address the symptoms and underlying condition.
Treatments to address conditions that may include:
- Antibiotics: If pneumonia or tuberculosis is present.
- Steroids: If inflammation or autoimmunity is causing the condition.
- Surgery and cancer treatment: If a malignant (cancerous) tumor is causing bleeding.
