Coughing up blood

Alternative names 
Hemoptysis; Spitting up blood; Bloody sputum

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

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)       o Bronchitis       o Bronchiectasis       o Laryngitis       o 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)       o From bleeding gums, such as with gingivitis       o Nosebleed (epistaxis)       o 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       o Is visible blood coughed up (gross hemoptysis)?       o Is there blood streaked sputum (phlegm)?       o Are large amounts of blood (massive hemoptysis) coughed up?       o Are there repeated episodes of coughing up blood?  
  • Time pattern       o Is the cough worse at night?       o Did it begin suddenly?       o Has it been increasing recently?       o How long has the cough lasted (for how many weeks?)       o 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.

Johns Hopkins patient information

Last revised: December 7, 2012
by Mamikon Bozoyan, M.D.

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All ArmMed Media material is provided for information only and is neither advice nor a substitute for proper medical care. Consult a qualified healthcare professional who understands your particular history for individual concerns.