Hemoptysis (Coughing Up Blood)

What Is Hemoptysis?

Hemoptysis is when you cough up blood from your lungs. It can be a sign of a serious medical condition. Infections, cancer, and problems in blood vessels in your lungs can cause it. Unless you have bronchitis, you need to see a doctor if you’re coughing up blood.

Hemoptysis is divided into types based on how much blood you cough up over 24 hours. But in some cases, it can be hard to tell.

• Nonlife-threatening or nonmassive hemoptysis. This is also known as moderate or submassive hemoptysis. You may cough up between 20 and 200 mL (about a cup) of blood.
• Scant or mild hemoptysis. You cough up less than 20 mL, less than a tablespoon.

Hemoptysis Causes

Many things can make you cough up blood. Common causes include:

• Bronchitis, either short-term (acute) or long-term (chronic)
• Lung cancer
• Damaged airways (bronchiectasis), especially because of cystic fibrosis
• Pneumonia
• Tuberculosis
• Chronic obstructive pulmonary disease (COPD)

Other causes include:

• Congestive heart failure, especially because of mitral stenosis
• Crack cocaine use
• Foreign objects in your airways
• Inflammatory or autoimmune conditions (such as lupus, granulomatosis with polyangiitis, microscopic polyangiitis, Churg-Strauss syndrome, Goodpasture disease, or Behcet disease)
• Lung abscess
• Non-cancerous lung tumors
• Parasitic infection
• Pulmonary arteriovenous malformations (AVMs)
• Pulmonary embolism
• An injury like a gunshot wound or car accident
• Use of blood thinners (anticoagulants)
• Endometriosis
• Hughes-Stovin syndrome
• Hereditary hemorrhagic telangiectasia
• Sarcoidosis

In some cases, doctors can’t find a cause, but the hemoptysis usually goes away within 6 months.

Hemoptysis vs. Similar Conditions

Your doctor will need to find out whether the blood is coming from your lungs, which is hemoptysis, or from your upper respiratory tract or upper digestive tract. This is called pseudohemoptysis. Or you could be vomiting blood, which is known as hematemesis.

• Hemoptysis causes sputum (the material you cough up) that’s bright red or pink and frothy.
• Pseudohemoptysis looks very similar. Tests might be the only way to tell the difference.
• Hematemesis brings up material that’s darker and looks like coffee grounds. It may be mixed with bits of food.

When to see a doctor

Acute bronchitis typically gets better on its own without treatment. If you have bronchitis and see small amounts of blood in the mucus for less than a week, it’s OK to watch and wait.

Coughing up blood can also be a sign of a serious medical condition. Call your doctor if you have any of these symptoms:

• Blood in mucus that lasts longer than a week, is severe or getting worse, or comes and goes over time
• Chest pain
• Weight loss
• Soaking sweats at night
• Fever higher than 101 degrees
• Shortness of breath with your usual activity level

Hemoptysis Diagnosis and Tests

If you’re coughing up blood, your doctor will do one or more of these:

• Medical history and physical exam . This helps them gather clues to identify the cause.
• Chest X-ray. This can show whether there’s a mass in your chest or areas of fluid or congestion in your lungs.
• CT scan . With detailed images of the inside of your chest, this test may reveal some causes for coughing up blood.
• Bronchoscopy . Your doctor runs a flexible tube with a camera on its end, called a bronchoscope, through your nose or mouth and into your windpipe and airways.
• Complete blood count (CBC). This test checks the number of white and red blood cells in your blood, along with platelets (cells that help blood clot).
• Urinalysis . Some causes of hemoptysis also show up on this simple urine test.
• Blood chemistry profile. This test measures electrolytes and how well your kidneys are working.
• Coagulation tests. Changes to your blood’s ability to clot, or coagulate, can lead to bleeding and coughing up blood.
• Arterial blood gas. This test measures the levels of oxygen and carbon dioxide in your blood. Oxygen levels can be low in people coughing up blood.
• Pulse oximetry. A probe (usually on a finger) tests the level of oxygen in your blood.

Hemoptysis Treatments

Treatment for hemoptysis depends on how much blood you’re coughing up and what’s causing it.

Life-threatening or massive hemoptysis

Your doctor will move you into the hospital’s intensive care unit (ICU). They may have you see a pulmonologist and a cardiothoracic surgeon, doctors who specialize in the chest and respiratory tract.

Your first treatment could include:

• A tube that goes into your airways (intubation)
• Extra oxygen (ventilation)
• A body position in which the lung with possible bleeding is lower than the other lung

When your doctor finds the source of the bleeding, they might try to stop it with:

• Iced saline
• Medications to narrow blood vessels (vasoconstrictors) like epinephrine or vasopressin
• Medicines to help blood clot (coagulants) like tranexamic acid
• Tiny balloons or cuffs to put pressure on the area (bronchial blockade or balloon tamponade)
• Laser therapy
• Argon plasma coagulation (APC)
• Cryotherapy
• Embolization

In rare cases, you may need surgery. This could involve:

• Taking out one section (lobe) of your lung
• Removing the entire lung

When you’re out of danger, your doctor will treat what’s making you cough up blood. You might get:

• Antibiotics for pneumonia or tuberculosis
• Chemotherapy or radiation for lung cancer
• Steroids for inflammatory conditions

If you have very thin blood because of medications, you may need transfusions of blood products or other medications to ease blood loss.

Nonlife-threatening or nonmassive hemoptysis

Treatment for the underlying condition will usually take care of bleeding that isn’t dangerous. If you have bronchitis, the most common cause of hemoptysis, your doctor may give you antibiotics. They might also recommend cough medicine.

If you smoke cigarettes, stop. It’s the best thing you can do for hemoptysis and for your overall health.

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