Cough with blood in mucus – Hemoptysis: Causes and Treatment

Summary

Hemoptysis is a condition in which the person coughs up blood in small to moderate amounts. It is symptom of an underlying condition. Although coughing small amounts of blood is not life-threatening in itself, the underlying condition can be serious and needs immediate attention. Coughing blood is often mistaken for vomiting blood, but they are not one and the same as the underlying causes are different for both of them. In this article, we will learn more.

What is Hemoptysis?

There are various conditions in which blood is expelled from the human body. When one is injured, blood can ooze out of cuts and bruises on the skin. Certain dental conditions can cause bleeding in the mouth and gums. While head and brain conditions can cause nose-bleeds, some rare conditions can cause bleeding from the ears. If one has certain kidney conditions, blood can be found in the urine. Certain cancers of the lower GI tract can cause blood in the stools, while various conditions of the upper GI tract can cause vomiting of blood. And menstruating women expel blood from their vaginas.

So also, blood can be expelled from the lungs, through coughing. The condition is called Hemoptysis. The quantum of blood expelled can be as less as a spoonful or as much as a cupful. The coughed-up sputum may be bright-red and frothy to look at, and slimy to feel, as the blood has got mixed with air and mucous in the lungs. So, what do pulmonologists consider to be the possible underlying causes of hemoptysis?

Causes

Bronchitis which is acute or chronic
Vasculitis
Pneumonia
Cystic fibrosis
Tuberculosis
Drug use (crack/cocaine)
Bronchiectasis: Damaged airways, generally due to cystic fibrosis
Injury to the arteries in the lungs
Complications from lupus
Congestive heart failure
Using blood thinners (anticoagulants)
Excessive coughing that irritates the throat
Irritation from a bronchoscopy biopsy
Chronic obstructive pulmonary disease (COPD)
Blood clot in the lung (pulmonary embolism)
Pulmonary aspiration (breathing blood into the lungs)
Lung cancer (especially in cigarette smoker over 40 years of age)
Blood entering the throat from the nose (nosebleed), tonsils or teeth, and then entering the lungs through the food-pipe or wind-pipe
Foreign body or obstruction in the airways of the lungs, which is a common occurrence with children
Congestive heart failure, especially because of mitral stenosis
Autoimmune conditions that cause inflammation such as lupus, Behcet disease granulomatosis with polyangiitis, Goodpasture disease, Churg-Strauss syndrome, microscopic polyangiitis, etc
Lung abscess (accumulation of pus in the lungs)
Non-cancerous lung tumours in the lung
Parasitic infections
Pulmonary arteriovenous malformations (AVMs), a vascular abnormality in the lungs
Injury due to vehicle collisions, sports injuries, stabbing and gunshot wounds
Use of anticoagulants (blood thinners)
Endometriosis
Sarcoidosis
Hereditary haemorrhagic telangiectasia
Hughes-Stovin syndrome
Lung injury from a recent medical procedure such as nasal surgery, laryngoscopy and tonsillectomy
Asthma
Severe heart failure
Abnormal tissue deposits in the lungs
Certain diagnostic procedures such as bronchoscopy, upper airway biopsy and spirometry

Also Read: What causes a person to vomit blood?

Types of Hemoptysis

Scant or mild hemoptysis: In this, the quantity of blood expelled is less than 20 mL, which is less than a tablespoon.
Non-life-threatening or non-massive hemoptysis. This is also called moderate or submassive hemoptysis. In this, the quantity of blood expelled is between 20 and 200 mL which is about a cup of blood.
Life-threatening or massive hemoptysis: The quantity of blood expelled is 200 ml to 600 ml, which is about a pint.

Other symptoms

According to pulmonologists, persons suffering from Hemoptysis may show other symptoms as well, such as:

Fever
Chest pain
Cough
Difficulty breathing or shortness of breath
Night sweats
Fatigue
Weight loss

Diagnosis

Chest X-ray: This looks for tumours or fluid in the lungs.
A CT scan of the chest: This is done to investigate findings from a chest X-ray or when a procedure like a bronchoscopy is done.
A bronchoscopy: This looks to see if the airways are clear and locate the spot where bleeding is happening.
A complete blood count (CBC): This will assess the quantity of blood lost and look for signs of infection.
A sputum culture: This looks for infections due to bacteria or viruses.
A blood clotting test (coagulation test): This will look for a bleeding disorder
Pulmonary arteriography: This examines how blood flows through the person’s lungs.
A urinalysis and/or kidney function test: This helps rule out autoimmune conditions that affect the lungs and kidneys.
Medical history and physical exam: This may give some clues to identify the cause.
Arterial blood gas: This measures the levels of oxygen and carbon-dioxide in the blood, considering that 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.
A ventilation-perfusion scan: This assesses the air-flow and blood-flow in the lungs
CT angiography: This is done to understand what may be causing bleeding in the lungs and how severe it is.
Lung biopsy: A sample of lung tissue is removed and examined under a microscope to understand the cause.
Lung VQ scan: This too assesses the blood-flow and airflow in the lungs.

Treatment

For scant and non-massive hemoptysis, one or more of the following options will be pursued. For massive hemoptysis, the treatment options will vary, on a case-to-case basis.

A bronchoscopy: This helps remove clots in the airways, which may be causing the bleeding.
Bronchial artery angiography: This stops blood-flow in those blood vessels which are causing the bleeding.
Endovascular embolization: as above
Medication: This stops the bleeding when there has been severe blood loss
Antibiotics: To treat pneumonia or tuberculosis
Steroids: If inflammation is causing the bleeding
Surgery and cancer treatment: If a cancerous, i.e. malignant tumour is causing the condition.

It’s crucial for patients dealing with hemoptysis to access specialized medical care. Kauvery Hospital, with its branches in Chennai, Hosur, Salem, Tirunelveli, and Trichy, provides comprehensive and expert care for such conditions.

Also Read: The 5 signs of Acute Respiratory Distress Syndrome

Frequently Asked Questions

What is hemoptysis?

Hemoptysis is the condition of coughing up blood from the lungs or airways.

What causes hemoptysis?

Causes include bronchitis, pneumonia, tuberculosis, lung cancer, blood clot in the lung, and other lung conditions.

What are the types of hemoptysis?

Types include scant/mild (less than 20 mL), non-life-threatening/moderate (20-200 mL), and life-threatening/massive (200-600 mL).

What are the symptoms of hemoptysis?

Symptoms may include coughing blood, fever, chest pain, difficulty breathing, night sweats, fatigue, and weight loss.

How is hemoptysis diagnosed?

Diagnosis may involve chest X-rays, CT scans, bronchoscopy, blood tests, sputum cultures, and other diagnostic procedures.

How is hemoptysis treated?

Treatment options include bronchoscopy, bronchial artery angiography, medications, antibiotics, steroids, and surgery, depending on the severity and cause.

Kauvery Hospital is globally known for its multidisciplinary services at all its Centers of Excellence, and for its comprehensive, Avant-Grade technology, especially in diagnostics and remedial care in heart diseases, transplantation, vascular and neurosciences medicine. Located in the heart of Trichy (Tennur, Royal Road and Alexandria Road (Cantonment), Chennai (Alwarpet & Vadapalani), Hosur, Salem, Tirunelveli and Bengaluru, the hospital also renders adult and pediatric trauma care.

Chennai Alwarpet – 044 4000 6000 • Chennai Vadapalani – 044 4000 6000 • Trichy – Cantonment – 0431 4077777 • Trichy – Heartcity – 0431 4003500 • Trichy – Tennur – 0431 4022555 • Hosur – 04344 272727 • Salem – 0427 2677777 • Tirunelveli – 0462 4006000 • Bengaluru – 080 6801 6801