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Coughing Up Blood (Haemoptysis): Causes, Symptoms, Diagnosis And Treatment

Coughing up blood (Haemoptysis)is the coughing up and spitting of blood or bloody mucous from your lungs or bronchial tubes [1]. Coughing up blood should not be confused with vomiting blood. Coughing up blood is a serious medical condition which should be diagnosed and treated on time. In this article, we will explain what causes coughing up blood, its symptoms, diagnosis and treatment.

What Causes Haemoptysis?

The causes of coughing up blood can range from mild to severe, which include the following:

• Tuberculosis.

• Bronchitis.

• Pneumonia.

• Lung cancer

• Bronchiectasis.

• Congestive heart failure.

• Blood clot in the lung.

• Pulmonary oedema.

• Pulmonary embolism.

• Cystic fibrosis.

• Vasculitis

• Foreign objects in your airways.

• Trauma to the airways.

• Lupus pneumonitis.

• Pulmonary endometriosis

• Using blood thinners.

• Inflammation and irritation of the airways due to repeatedly coughing.

• Lung abscess.

Coughing up blood occurs in 10 per cent of patients with chronic lung disease. It usually occurs in adults aged 62 years and it rarely affects children [2].


Haemoptysis In Children

Lower respiratory tract infection is the primary cause of coughing up blood in children followed by foreign body aspiration (a foreign body that enters the child's lungs and causes choking) [3]. It most commonly occurs in children younger than four years according to the American Family Physician.

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Symptoms Of Haemoptysis

The blood will appear bubbly when it comes out from the lungs or respiratory tract because the blood has been mixed with air and mucous in the lungs.

The blood from the respiratory tract will be bright red, foamy blood and you will experience difficulty in breathing and a feeling of warmth in the chest.

It is important to distinguish between coughing up blood (haemoptysis), blood that comes from the upper gastrointestinal tract or the upper respiratory tract i.e the mouth, nose or throat (pseudohemoptysis) and the vomiting of blood (hematemesis) [4].


When To See A Doctor

Consult your doctor immediately, if you experience the following:

• If you cough up blood after a fall or injury to the chest.

• If you experience chest pain, fever, light headedness, dizziness or shortness of breath.

• Blood in mucous that lasts longer than a week.

• If you cough more than a few teaspoons of blood. Haemoptysis is considered massive if the blood is between 100 and 1000 ml in 24 hours, but in most cases, it could range from 300 to 600 ml. Haemoptysis is considered nonmassive if blood loss is less than 200 ml per day [5], [6].

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Diagnosis Of Haemoptysis

The doctor will examine your chest and lungs and ask about your medical history. In addition, your doctor will further ask certain questions such as how long have you been coughing up blood, when did it start, how much blood have you been coughing up, how much blood is mixed with mucous, what symptoms are you experiencing and what medications are you taking.

Depending on the amount of blood you are coughing up, the doctor will conduct further tests. These include the following: [7]

CT scan of your chest - To show the detailed images of the inside of your chest.

Chest X-ray - To look for infection or fluid congestion in your lungs.

Bronchoscopy -A flexible tube is inserted through your mouth and into your airways to check your lungs.

Lab tests - To check for blood counts.

Lung biopsy - Removing a piece of tissue from the lungs for examination.

Lung VQ scan - To check the blood flow and airflow to the lungs.

Pulse oximetry - To check the level of oxygen in your blood.

Pulmonary angiography - To check the blood flow in the lungs.

Urinalysis - A urine test to rule out the cause of coughing up blood.


Treatment Of Haemoptysis

Haemoptysis is treated depending on the cause.

• If throat irritation due to excessive coughing causes coughing up blood, it can be treated with cough suppressants.

• Bronchial arterial embolisation, a treatment procedure that can help control and stop the bleeding [8]. It is the safest and most effective treatment option for massive or recurrent haemoptysis.

• Surgery is recommended if it's bleeding from tumours or in certain cases such as traumatic or iatrogenic pulmonary injury [9].

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Prevention Of Haemoptysis

With proper diagnosis and treatment, the underlying causes of haemoptysis can be managed. In addition, stop or abstain from smoking and avoid breathing in polluted air as they can help prevent lung problems. Also, if you are coughing excessively, consult a doctor to prevent it from worsening.

Common FAQs

Q. Can coughing up blood be nothing?

A. Coughing up blood could be a sign of a serious underlying medical condition. If the blood is more than a few teaspoons and persisting for more than one week, seek medical attention immediately.

Q. Can pneumonia cause haemoptysis?

A. Yes, pneumonia is one of the causes of haemoptysis.

Q. What happens when you cough up blood and mucous?

A. Coughing up blood with mucous could be a sign of serious infection in the lungs.

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