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Blood in sputum (Hemoptysis) – What it is, Symptoms and Causes

This post is also available in: हिन्दी (Hindi)

What is hemoptysis?

It is defined as coughing up blood alone or mixed up with mucus occurring from the lower respiratory tract (lungs or bronchial tubes).

blood in sputum - hemoptysis

How does it all happen?

Generally, the lung blood circulation (95%) is through low-pressure pulmonary arteries and ends up in the pulmonary capillary bed, where gaseous exchange happens. Near about 5% of the blood circulates through high-pressure bronchial arteries, which originate at the aorta and supply major airways and supporting structures.

In case of hemoptysis, the blood generally arises from this bronchial circulation, except when pulmonary arteries are damaged by trauma, by the erosion of a granulomatous or calcified lymph node or tumor, or, rarely, by pulmonary arterial catheterization or when pulmonary capillaries are affected by inflammation.

Hemoptysis Causes:

• Infection: bacterial, virus or TB

COPD

• Trauma

• Lung cancer

• Lung abscess

• Pneumonia

• Goodpasture’s syndrome

• Lupus

• Pulmonary hemosiderosis

• Bronchiectasis

• Acute/ Chronic Bronchitis

• Arteriovenous malformation

• Pulmonary embolism

• High Pulmonary venous pressure

• Drug use

• Foreign body

• Smoking

Other than the lower respiratory tract

• Upper airway trauma

• Gastrointestinal bleed

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Hemoptysis Symptoms :

• Mild coughing-up of blood: traces of blood to few drops of blood.

• Moderate<600 ml of blood within 24 hours.

• Massive<600 ml of blood within 24 hours.

Red alert sign:

• Massive hemoptysis

• Back pain

• Presence of a pulmonary artery catheter or tracheostomy

• Malaise, weight loss, or fatigue

• Extensive smoking history

• Dyspnea at rest or absent or decreased breath sounds

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Hemoptysis Diagnosis

• Sputum test: The patient is asked to cough out the sputum into a container. Generally from a deep cough and in the morning. Patients are advised to have plenty of fluids to loosen up the secretions. At least 2 milliliters of sputum is required by the laboratory as an adequate sample.

Hemoptysis Treatment:

• Treat the cause: Antibiotics for infection/ TB, chemotherapy/ radiation for lung cancer, and steroids for inflammatory conditions.

• Bronchial artery embolization: to localize, block, and stop the bleeding from bronchial arteries in severe cases of tuberculosis or damage to the arteries due to trauma or other reasons.

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