Hemoptysis (Coughing Up Blood)

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What is Hemoptysis (Coughing Up Blood)?

Hemoptysis is the medical term for coughing up blood. The blood comes from the lungs. Coughing up blood can be a sign of a serious medical condition. If you do not have bronchitis but experience coughing up blood, you should seek immediate medical attention.

Hemoptysis is divided into several types, depending on the amount of blood that comes out within a period of 24 hours. Types of hemoptysis include: 

Massive hemoptysis

Massive hemoptysis is a life-threatening condition. Some researchers have different guidelines for this type of hemoptysis. The amount of blood expectorated varies from 100ml to 600ml.

Non-Massive hemoptysis 

Non-massive hemoptysis is not considered life-threatening. This type of hemoptysis is also known as moderate hemoptysis or submassive hemoptysis. The amount of blood expectorated ranges from 20ml to 200ml.

Mild hemoptysis

In this type of hemoptysis, the amount of blood expectorated is less than 20ml.

Causes of Hemoptysis (Coughing Up Blood)

Some common causes of hemoptysis are: 

  • Acute and chronic bronchitis
  • Lung cancer
  • Respiratory tract problems, usually due to cystic fibrosis
  • Pneumonia
  • Tuberculosis
  • Chronic obstructive pulmonary disease (COPD)

Possible other causes may include: 

  • Congestive heart failure, usually due to mitral stenosis (blockage of blood flow from the left atrium to the left ventricle of the heart)
  • Abuse of drugs such as cocaine
  • Foreign objects in the respiratory tract
  • Inflammation or autoimmune conditions such as lupus, granulomatosis with polyangiitis, microscopic polyangiitis, Churg-Strauss syndrome, Goodpasture’s disease, or Behcet’s disease
  • Purulent swelling of the lungs
  • Non-cancerous lung tumors
  • Parasite infection
  • Pulmonary arteriovenous malformations (AVMs)
  • Pulmonary embolism
  • Injuries such as gunshot wounds or accidents
  • Use of drugs to prevent blood clots (anticoagulants)
  • Endometriosis
  • Hughes-Stovin Syndrome
  • Hereditary hemorrhagic telangiectasia
  • Sarcoidosis

In some cases, doctors may not able to identify the cause of hemoptysis. However, hemoptysis will usually disappear in six months.

When to See a Doctor for Hemoptysis (Coughing Up Blood)

Acute bronchitis usually resolves on its own without having to undergo treatment. If you have bronchitis and notice a little blood on the phlegm when you cough, this may happen for less than a week. You simply have to wait until the blood disappears from your phlegm.

If you have any of the symptoms below, seek medical help immediately:

  • Blood in your phlegm for more than a week
  • Worsened phlegm, or appears and disappears over time
  • Chest pain
  • Weight loss
  • Night sweats 
  • Fever above 38 degrees Celsius
  • Shortness of breath even if you only do your usual activities

Before diagnosing a patient with hemoptysis, the doctor needs to carry out a detailed examination to ensure that blood really comes from the lungs – as there are several diseases that have similar symptoms.

The differences between hemoptysis and other similar diseases are:

  • Hemoptysis causes your phlegm to be bright red, or pink and foamy.
  • Pseudohemoptysis has a very similar look. The only way to find out the difference is to get a test at the hospital.
  • Hematemesis causes the material released to be dark-colored and look like coffee pulp. Sometimes, it is also mixed with pieces of food.

How to Diagnose Hemoptysis (Coughing Up Blood)?

If you have hemoptysis, your doctor will likely perform the following:

  • Check on your medical history and perform physical tests.
  • Perform an X-ray on the chest to determine if there is a fluid clot or a blockage in the lungs.
  • Perform a CT scan to determine the cause of hemoptysis
  • Perform a bronchoscopy by inserting a camera tube (called a bronchoscope) through the nose or mouth into the throat and respiratory tract.
  • Perform a complete blood count (CBC) test to determine the number of white blood cells and red blood cells
  • Perform a urine test.
  • Look at the chemicals in the blood to measure electrolytes and observe the performance of the kidneys.
  • Perform a coagulation test. If you are unable to perform blood clotting properly, you may experience coughing up blood. 
  • Look at the blood gas in the arteries to measure oxygen levels and carbon dioxide in the blood. People who cough up blood usually have low oxygen levels.
  • Perform pulse oximetry on the finger to test oxygen levels in the blood.

Treatment for Hemoptysis (Coughing Up Blood)

Available treatments for hemoptysis vary, depending on the type of hemoptysis you suffer from. However, the main purpose of the treatment is to stop the cause of bleeding, then treat the cause. If it is caused by an infection, your doctor will likely prescribe medications. If you experience severe bleeding, you will then be hospitalized.

In massive life-threatening hemoptysis, the following will likely be done: 

  • Your doctor will transfer you to the ICU
  • A tube will be inserted into your respiratory tract
  • You will be given additional oxygen
  • The position of your body will be adjusted, where the affected lung will be positioned lower than the other lung

When your doctor has found the source of the bleeding, he or she will likely stop it by:

  • Frozen saline
  • Medicines to narrow blood vessels (vasoconstrictors) such as epinephrine or vasopressin
  • Medicines to help blood clot (coagulants) such as tranexamic acid (tranexamic acid)
  • A small balloon to apply pressure to the area of ​​the wound
  • Laser therapy
  • Argon plasma coagulation (APC), which is a procedure to control bleeding using argon gas
  • Cryotherapy, which is a procedure to freeze the surface of the skin with a special substance
  • Embolization, which is a minimal non-surgical procedure, usually performed on arteries

In some cases, you may need surgery: 

  • Take a small part of your lung
  • Remove all parts of the lung

When you have passed a critical period, your doctor will give you medications to treat hemoptysis, such as:

  • Antibiotics for pneumonia or tuberculosis
  • Chemotherapy or radiation for lung cancer
  • Steroids for inflammation

If your blood count is thinning due to the medicines given, you may need blood transfusions or other medications to reduce blood loss.

Meanwhile, in non-massive or non-life-threatening hemoptysis, the cause is usually not serious. If you have bronchitis, your doctor will usually give you antibiotics. Sometimes, a cough medicine may also be recommended.

Treatment Cost for Hemoptysis (Coughing Up Blood)

Treatment cost for hemoptysis varies, depending on your choice of hospital, the cause, as well as the medical treatments chosen.

To find out the estimated treatment cost for hemoptysis, hospital recommendations, or to make an appointment with your doctor, contact Smarter Health.

Prevention of Hemoptysis (Coughing Up Blood)

If you are a smoker, you are highly recommended to quit. This will help eliminate coughing up blood. You will also achieve overall improved health.

Avoiding outdoor areas when pollution is high and smoky fog can also help prevent hemoptysis. 

If you have hemoptysis and you contact a doctor, remember carefully the shape, color, and texture of the blood coming out. It is important for your doctor to be able to know the cause of hemoptysis.

Home Remedies for Hemoptysis (Coughing Up Blood)

The first thing you should do if you or someone near you coughs up blood is to stay calm. You can do the following:

  • Sit in a half-seated position so you can breathe better.
  • Apply cold compress to your chest, as usually coughing up blood is followed by a feeling of heat that appears on the chest.
  • Drink warm mineral water to reduce throat pain. When experiencing coughing up blood, you should have sufficient fluid intake so that the cough does not get worse. However, if you have a history of heart, kidney or liver disease, consult your doctor first before increasing your fluid intake.
  • Notice if there are signs of shock after coughing. If there are signs of shock, immediately seek help to avoid other negative side effects.

Make a saline solution, then apply or drip on the nose and throat. This fluid can help reduce and stop bleeding that occurs. After that, seek medical help immediately.  

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