Hemoptysis refers to the coughing or spitting of blood from the respiratory tract organs namely lungs, bronchi, trachea or larynx. Hemoptysis might occur due to the breaking of small blood vessels lining the lung airways. Hemoptysis might be harmless when it happens due to irritation of the bronchial tubes in bronchitis or it might be a sign of a serious underlying condition like lung cancer. Certain infections like Pneumonia, Tuberculosis, Bronchitis and some cardiovascular conditions might be responsible for Hemoptysis.
If coughing up blood is around 300ML it is considered huge. In such a case, there are severe injuries. The risk is mainly from choking not from blood loss. Hemoptysis generally needs medical supervision unless the coughing up of blood is because of bronchitis.
Bloody sputum can arise from general infections in the airways and lungs like bronchitis and pneumonia. Bloody sputum can also be an indication of lung cancer. In any situation when the problem of bloody sputum cannot be assigned to a particular condition or problem, a comprehensive evaluation of the lungs is carried out.
It is a symptom of various underlying ailments. In addition to coughing up of blood, various other signs may be experienced depending on what is causing the bloody sputum. Some of these symptoms are:
Pain in the chest or a feeling of tightness, Dyspnea which means experiencing shortness of breath even without doing any heavy physical or laborious task or exercise, Fever, Tachypnea which means rapid breathing, Vomiting and Nausea.
Patients should not be confused between hemoptysis and hematemesis. Hemoptysis is characterized by respiratory symptoms like coughing, blood that appears to be in liquid form or clotted form, and has a bright red colour and a frothy appearance. On the other hand, hematemesis has characteristics such as brown or black blood, Melena a condition with dark coloured stools, history of excessive alcoholism, history of liver disease and esophagogastric symptoms like vomiting and nausea.
Even without any of the above symptoms, individuals should contact their physician or healthcare practitioner in case they are coughing up blood. In most of the cases, coughing up blood is associated with a mild bronchitis infection but it should not be treated lightly as it can be a sign of a harmful and serious underlying condition.
Causes of bloody sputum include:
Pneumonia along with lung infection : Many lung infections can lead to coughing up of blood. Pneumonia is a lung infection which can be a serious and deadly disease. This condition leads to inflammation of the lungs along with fluid-filled alveoli. Pneumonia is a high-risk disease for people with compromised immune systems, infants, people suffering from other diseases and older adults, but it can also occur in healthy and young individuals. This disease is one of the most frequent causes of death because of infection in children less than the age of 5, globally.
Early symptoms include the symptoms that look like those of the flu. The patient subsequently suffers from high fever accompanied by chills and cough along with sputum. Some of the common symptoms are pleuritic pain which is the pain experienced while taking deep breaths, rapid breathing along with shortness of breath, cough with green phlegm, headaches, muscle pains, the purplish colour of the skin due to inadequate oxygen, sweating, diarrhoea, weakness etc.
Pneumonia caused by bacteria is mainly treated with antibiotics whereas pneumonia which is viral in nature is cured by taking rest and drinking plenty of fluids. Pneumonia caused by a fungus is treated with antifungal medicines. Hospitalization is not common but might be required if the condition is deteriorating or the patient has a weak immune system.
Bronchitis : Chronic bronchitis is one of the major reasons for the appearance of blood in sputum. It is caused by the inflammation of the bronchial tubes which leads to the production of a lot of mucus. Smoking cigarettes are one of the most common causes. Air pollution and breathing dust over long durations are also one of the causes.
It is a condition which persists for a long time and might recur at frequent intervals. It is often treated with anti-inflammatory medicines and might also need oxygen therapy.
Severe Nosebleed : Epistaxis or a severe nosebleed is a situation in which the nasal cavity experiences severe bleeding. It might be a result of a trauma to the nose. It is commonly experienced by children and older people.
Common symptoms of excessive nosebleed include bleeding in the teeth, gums, the presence of blood in urine and easy bruising indicate an inability of the blood to clot. This is not a serious condition and is self-treatable, however, if home remedies don’t work, a doctor should be consulted.
Chronic obstructive pulmonary disease : COPD is a condition which causes an obstruction of the lungs. It is mainly caused by long-term exposure to irritants that cause damage to the lungs. At the onset, there might be no symptoms but the symptoms usually become worse with time. These include tightness in the chest, wheezing, production of mucus while coughing etc. Tests like imaging tests, blood tests and lung function tests are used for diagnosis of the condition. There is no available cure but treatment relieves the symptoms.
Bronchiectasis : It is a condition which causes permanent enlargement, widening, damage and thickening of the bronchial tubes of the lungs. The damaged airways cause frequent infections in the airways. There is no cure for the condition but it can be managed with proper treatment. Serious episodes should be treated immediately and properly so that no further damage is done to the lungs.
Anticoagulants : These are medications which prevent blood clots. They are also known as blood thinners and help in prolonging the time taken for blood to clot.
Severe or prolonged cough : This leads to irritation in the upper respiratory which ultimately leads to the tearing of blood vessels which leads to bloody sputum.
Drug Use : Drugs that are inhaled through the nostrils can often cause irritation in the upper respiratory system and lead to coughing up of blood.
Lung Cancer : Individuals that are at high risk include people over the age of 40 and people who smoke tobacco frequently or on a regular basis. The most basic symptom is a cough that persists along with bloody sputum and does not go away. Wheezing, pain in the chest and shortness of breath are some other symptoms. It might also cause bone pains sometimes.
Pulmonary embolism : It is a condition which causes a blood clot in one of the arteries of the lungs. Common signs of pulmonary embolism include difficulty in breathing, pain in the chest, shortness of breath, coughing or coughing up of blood.
Neck Cancer : This might start in the oesophagus, larynx or windpipe. People with high smoking and alcohol addiction are at high risk for this disease. Symptoms include persistent soreness in the throat, development of a red or white patch on the mouth, swelling or soreness in the throat. Treatment depends on the nature of the location of cancer.
Tuberculosis : It is a bacterial infection which can result in heavy infection of the lungs causing fevers, chills, sweating, painful breathing, persistent cough, blood-stained sputum etc.
Narrowed heart valves : Narrowing of the valves of the heart often causes shortness of breath, mostly along with physical exercise. Other symptoms include heart palpitations, fatigue, weakness etc.
Cystic fibrosis : It is a hereditary condition which causes severe damage to the lungs of the affected individual. It results in difficulty in breathing along with a cough that persists and leads to the production of thick mucus, sometimes streaked with blood.
Granulomatosis with polyangiitis : It is a condition that is characterized by the inflammation of the blood vessels present in kidneys, sinuses and lungs. Common symptoms include a bleeding nose, fevers, shortness of breath, wheezing and a runny nose.
A serious injury : Any injury which causes a trauma to the chest can result in hemoptysis or presence of blood in the sputum.
It is really important to see a doctor immediately if you cough up a lot of blood, or blood comes out when you cough at a frequent rate. If the blood you coughed out has chunks of food in it and is dark in colour rush to the hospital immediately. This can be an indication of a major problem in your digestive tract.
Coughing up blood is a symptom of many other diseases. It is also advised that you see a doctor if any of these symptoms take place along with blood in sputum:
A loss in your daily appetite
2. Unexplained weight loss
3. Urinating blood
4. Fever, pain in the chest, nausea, dizziness or light-headed
5. Shortness of breath getting worse
To determine that the blood in sputum is being caused by any medical condition, doctors check your medical history and take your physical examination. The doctors ask the person to cough during their examination. The doctors will also keep checking for blood in mouth and nose of the patient. Additional examinations such as chest X-ray, bronchoscopy in which the doctor inserts a tube with a camera on the one end into the airway, Computed Tomography (CT scans), Complete blood count (CBC), Urinalysis or urine test, Blood chemistry profile check, Coagulation tests, Arterial Blood Gas check or Pulse Oximetry may also be conducted in a few cases.
Treatments main goals are to stop the underlying problems and the bleeding. Treatment for these problems include:
1. Steroids – In cases of inflammatory conditions causing the coughing up of blood, steroids can be used. Steroids used to reduce the inflammatory chemicals in the body to prevent or reduce the tissue damage to the minimum. They also affect the activity of your immune system by affecting white blood cell’s functioning. In many diseases the immune system starts overworking which causes inflammation chemicals to damage the tissues, this is why steroids are used.
2. Antibiotics – Antibiotic are used in case of pneumonia or tuberculosis. Antibiotics stop these diseases from getting fatal or from worsening the conditions of the patient.
3. A bronchoscopy – A bronchoscopy is done to get a closer look into the problems in the sputum. It is done to identify the causes of any bleeding. An Endoscope is inserted into the airway of the patient with a camera attached to the instrument’s end. Other devices to fix the issue causing the bleeding or to remove a blood clot can be attached to the instrument as well.
4. Embolization – A catheter is passed into blood vessels if a blood vessel is the cause of the problem. The source is then identified and sealed off using a metal coil, a fragment of a gelatin sponge or a few chemicals responsible for clotting. This procedure of fixing the blood vessels is known as embolization.
5. Blood Product Transfusion – If excessively thin blood or clotting problems are the reason for excessive bleeding in sputum, A blood transfusion or a transfusion of other elements in blood such as clotting agents, plasma, red blood cells, white blood cells or platelets is required. In the early days, the blood transfusion was done to replace the blood completely. But, nowadays modern medical practices have made it possible to replace just components of the blood and not of all of it.
6. Chemotherapy – A chemotherapy or radiotherapy is used for lung cancer. A chemotherapy is the most commonly used method to stop cancer using medications or drugs that stop cancer cells from growing and dividing. It kills off the dividing cells. The effectiveness depends on the stage of cancer. Radiotherapy or radiation therapy is another common method of treating cancer. Radiations are used against tumours confined in an area, this stops a tumour from spreading further and helps in removing the tumour.
7. Surgery – A surgery may be required to remove or replace cancerous portions of the lungs. Surgery is the last resort for all the doctors when the bleeding cannot be stopped any other way and the bleeding keeps getting severe day by day.
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