Coughing up blood

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Coughing up blood

Definition:

Coughing up blood is the expectoration or spitting up of blood or bloody mucus from the lungs, throat, or mouth.

Alternative Names:

Hemoptysis; Spitting up blood; Bloody sputum

Considerations:

Coughing up blood from the lungs (hemoptysis) is sometimes confused with bleeding from the mouth, throat, or gastrointestinal tract.

Hemoptysis often looks frothy because it is mixed with air and sputum (secretions from the airway). It is usually bright red.

Common Causes:

Pulmonary infection (bacterial or viral infection in the lung or airway)
- Bronchitis
- Bronchiectasis
- Laryngitis
- Pneumonia
Lung cancer (see metastatic lung cancer)
Irritation of the throat from violent coughing
Pulmonary embolus
Cystic fibrosis
Pulmonary aspiration (inhaling blood into the lungs)
- From bleeding gums, such as with gingivitis
- Nosebleed (epistaxis)
- Tonsillectomy
Diagnostic tests, such as bronchoscopy, upper airway biopsy, laryngoscopy, lung biopsy, mediastinoscopy, or spirometry
Tuberculosis (TB)
Pulmonary edema
Systemic lupus erythematosus (SLE)
Goodpasture's syndrome
Wegener's granulomatosis

Home Care:

It is important to note the length of time during which hemoptysis occurs. Also important is whether it consists of mostly sputum with a small amount of blood, sputum and blood in nearly equal proportions, or nearly all blood.

Also, note any symptoms, such as lightheadedness, dizziness, or thirst, that might indicate a severe amount of blood loss. Other symptoms, such as fever, chest pain, shortness of breath, and blood in the urine may also be important.

For irritation of the throat from violent coughing, cough suppressants may help. Specific treatment of the underlying cause may be recommended by the doctor.

Cough suppression may or may not be desirable. Cough suppressants can prevent blood from spreading through the lungs, but they can also lead to airway obstruction from blood that accumulates.

Call your health care provider if:

If there is any unexplained coughing up of blood, call an ambulance or go to the nearest emergency department. This is very important if your cough produces large volumes of blood (more than a few teaspoons), or if it is accompanied by severe shortness of breath, lightheadedness, or dizziness.

What to expect at your health care provider's office:

In emergency cases, treatment will be aimed at stabilizing your condition. After you are stable, your health care providers will obtain a full medical history.

Medical history questions documenting your cough in detail may include:

Type
- Is visible blood coughed up (gross hemoptysis)?
- Is there blood streaked sputum (phlegm)?
- Are large amounts of blood (massive hemoptysis) coughed up?
- Are there repeated episodes of coughing up blood?
Time pattern
- Is the cough worse at night?
- Did it begin suddenly?
- Has it been increasing recently?
- How long has the cough lasted (for how many weeks?)
- What other symptoms are also present?

Physical examination will include thorough examination of the chest and lungs.

Diagnostic tests that may be performed include:

Chest x-ray
Chest CT scan
Complete blood count
Coagulation studies such as PT or PTT
Bronchoscopy
Lung biopsy
Lung scan
Pulmonary arteriography
Sputum culture and smear

After seeing your health care provider, you may want to add a diagnosis related to coughing up blood to your personal medical record.

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