Coughing up blood—medically known as haemoptysis—can be a terrifying experience. This article helps you understand what it means, whether it's serious, and how doctors identify and treat it.
What Is Haemoptysis?
- Definition: expectoration of blood from the lungs
- Differentiation: true vs spurious haemoptysis
- Appearance: frothy pink (alveolar), bright red (proximal)
True vs Spurious Haemoptysis
Spurious Haemoptysis
- Blood from mouth, nose, throat
- Dental abscess, nosebleeds, tumors
- Vitamin C deficiency (scurvy)
- Painful oral ulcers, nasal tumors
True Haemoptysis
- Originates from respiratory tract: lungs, bronchi, trachea
- Often associated with coughing, dyspnea, or infection
Key Signs and Symptoms
- Bright red vs pink frothy blood
- With/without sputum
- Episodic or continuous
- Associated features: fever, chest pain, weight loss, wheezing
Causes of Haemoptysis by Location
Larynx and Trachea
- Foreign body
- Trauma
- Carcinoma (hoarse voice, stridor)
Bronchi
- Bronchiectasis: purulent sputum, chronic cough
- Carcinoma: weight loss, hemoptysis, recurrent infections
- Adenoma
- Foreign body
Lungs
- Tuberculosis: night sweats, weight loss, chronic cough
- Pneumonia: fever, productive cough, pleuritic pain
- Lung abscess: foul-smelling sputum, clubbing
- Pulmonary embolism: chest pain, breathlessness
- Aspergilloma
- Infarction
Cardiovascular Causes
- Mitral stenosis: recurrent infections, pink sputum
- LVF (Cardiac failure): pulmonary edema
Important Clinical Clues
- TB: chronic illness signs
- Pneumonia: systemic illness with sputum
- Abscess: foul smell, poor oral hygiene
- PE: acute onset, chest pain, hemoptysis
- Carcinoma: weight loss, smokers, age >40
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When Haemoptysis Is a Medical Emergency
- Massive bleeding (>200 ml in 24 hrs)
- Associated with dyspnea, hypoxia
- Sudden onset without infection
- Suspected malignancy or PE
Diagnostic Workup for Haemoptysis
Initial Labs
- FBC (for infection, anemia)
- Clotting profile
- Sputum analysis: MC+S, cytology
Imaging
- Chest X-ray (AP & Lateral) – first step
- CT Scan (detects tumors, emboli, cavities)
- CT Pulmonary Angiography – best for PE
Special Investigations
- Bronchoscopy: tumor, foreign body
- ECG + Echocardiogram: cardiac causes
- D-dimer, V/Q scan: for infarction
Management of Haemoptysis
1. Supportive Measures
- Positioning (bleeding lung down)
- Oxygen therapy
- IV fluids and blood if needed
2. Treat Underlying Cause
- TB: Antitubercular therapy
- Pneumonia: Antibiotics
- Abscess: Drainage + antibiotics
- Carcinoma: Surgery, chemo, radiotherapy
- Bronchiectasis: Airway clearance, antibiotics
- Mitral stenosis: Valve intervention
3. Emergency Interventions
- Bronchial artery embolization
- Rigid bronchoscopy for bleeding control
- Surgery if bleeding persists
Red Flags and Referral Criteria
- Age >40, smoker, weight loss
- Recurrent episodes
- No clear infection
- Frothy sputum with no infection (cardiac origin)
- Sudden unexplained hemoptysis
Prevention and Prognosis
- Early management of infections
- Regular screening in high-risk groups (smokers, TB history)
- Good oral hygiene
- Prognosis depends on underlying cause
Related read: Neck Lump – Symptoms Explained
FAQs About Haemoptysis
Is coughing up blood always serious?
Not always—but it should never be ignored.
What does pink frothy sputum mean?
Usually indicates pulmonary edema (cardiac cause).
Can smoking cause haemoptysis?
Yes. Increases risk of bronchitis, carcinoma, and infections.
What test confirms the cause of haemoptysis?
Bronchoscopy and CT scan are most definitive.
Can haemoptysis go away on its own?
Minor cases due to infection can, but it must be evaluated.
Conclusion
Haemoptysis is a symptom, not a diagnosis. Understanding its origin—from mouth to lungs—is crucial. Whether it’s a simple infection or a sign of something more serious, prompt evaluation and management can save lives.
