Coughing Up Blood (Hemoptysis)

What Is Hemoptysis?

Hemoptysis is when you cough up blood. 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 Causes

Many things can lead to hemoptysis. Causes of coughing up blood include:

  • Bronchitis (acute or chronic), the most common cause of coughing up blood. Hemoptysis due to bronchitis is rarely life-threatening.
  • Bronchiectasis
  • Chronic obstructive pulmonary disease (COPD)
  • Congestive heart failure, especially due to 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)
  • Lung abscess
  • Lung cancer
  • Non-cancerous lung tumors
  • Parasitic infection
  • Pneumonia
  • Pulmonary arteriovenous malformations (AVMs)
  • Pulmonary embolism
  • Trauma, such as a gunshot wound or car accident
  • Tuberculosis
  • Use of blood thinners (anticoagulation)

Hemoptysis can also come from bleeding outside your lungs and airways. Severe nosebleeds or vomiting up blood from your stomach can make blood drain into your windpipe (trachea). You cough up the blood, and it appears as hemoptysis.

Often, no cause is ever found. Unexplained hemoptysis usually goes away within 6 months.

Hemoptysis Diagnosis Tests

If you’re coughing up blood, your doctor will first need to learn how much blood you’ve lost and whether it has affected your breathing. They’ll then look for a cause. Tests for coughing up blood include:

  • History and  physical exam . This helps your doctor gather clues to identify the cause.
  • Chest X-ray. This test can show whether there’s a mass in your chest or areas of fluid or congestion in your lungs.
  • CT scan . By showing detailed images of the inside of your chest, a CT scan can reveal some causes for coughing up blood.
  • Bronchoscopy . Your doctor runs a bronchoscope (a flexible tube with a camera on its end) through your nose or mouth and into your windpipe and airways. This way, they may be able to identify the cause of your hemoptysis.
  • 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 . Certain causes of hemoptysis also show up on this simple urine test.
  • Blood chemistry profile. This test measures electrolytes and kidney function, which may not be in a normal range with some causes of hemoptysis.
  • Coagulation tests. Changes to your blood’s ability to clot, or coagulate, can lead to bleeding and coughing up blood.
  • Arterial blood gas. A test of 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.

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Hemoptysis Treatments

If you’re coughing up blood, your doctor’s first goal will be to stop the bleeding. Treatments include:

  • Bronchial artery embolization. Your doctor runs a catheter through your leg, into an artery supplying blood to the lungs. They put dye into it and look at the arteries on a video screen to identify the source of your bleeding. They can block the source using metal coils or another substance. Bleeding usually stops, and other arteries compensate for the newly blocked artery.
  • Bronchoscopy. Tools on the end of an endoscope can treat some causes. For example, a balloon inflated inside the airway may help stop bleeding.
  • Surgery. If the reason you’re coughing up blood is severe and life threatening, you may need surgery to remove all or part of your lung (pneumonectomy).

Next, your doctor will treat what’s making you cough up blood. You might get:

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

Coughing Up Blood: When to See a Doctor

The most common reason for coughing up blood is acute bronchitis, which 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 carefully and wait for it to improve.

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

You’ll probably get treated in a hospital until doctors find the cause and the threat of serious bleeding passes.

WebMD Medical Reference Reviewed by Paul Boyce, MD on October 08, 2019

Sources

SOURCES:

Mason, R. Murray and Nadel’s Textbook of Respiratory Medicine, 5th edition, Saunders, 2010.

Cahill, B.C. Clinics in Chest Medicine, 1994; vol 15: pp 147-167.

Hirshberg, B. Chest, 1997; vol 112: pp 440-444.

Adelman, M. Annals of Internal Medicine, 1985; vol 102: pp 829-834.

Chang, J.C. Sarcoidosis, 1987; vol 4: pp 49-54.

Merck Manual Consumer Version: “Coughing Up Blood.”

UpToDate: “Etiology and Evaluation of Hemoptysis in Adults,” “Airway Foreign Bodies in Adults.”

Mayo Clinic: “Coughing Up Blood.”

Cleveland Clinic: “Granulomatosis with Polyangiitis (GPA, formerly called Wegener’s).”

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