Be it simply blood-stained sputum or large volumes of blood, the moment that you expectorate blood is almost always sure to induce concern. Yet by knowing about the possible causes, and the steps one could take, coughing up blood (hemoptysis) may be an anxious but not necessarily a helpless experience.
Coughing up blood can originate either from causes within the respiratory tract, the nasal passages, from cardio-vascular diseases, gastrointestinal sources or in some cases, from extreme internal trauma. True hemoptysis derives blood from the respiratory tract, coughing blood from the gastrointestinal region is defined as hematemesis and blood in the sputum coming from nasal bleeding or other sources is called pseudohemoptysis.
Observing other symptoms that accompany blood in the sputum is vital in diagnosing the source of the condition. Expectorating dull red to brown blood coupled with abdominal pains, and brown to dark stool usually indicates gastrointestinal bleeding, perhaps from disease or from trauma. Frothy, pinkish blood in foamy clear to yellowish green sputum accompanied by shortness of breath, chest pain or itchiness and mild fever is indicative of pulmonary sources. Volume could indicate severity and cause. Small amounts of blood infrequently can usually be treated promptly and symptoms would subside usually after several days to a few weeks. Massive volumes of blood (200-1000L per day, or on average 600ml/day) indicate severe causes, and should be addressed immediately.
Vomiting and coughing up of blood indicates gastro-intestinal causes. Ulcers and irritations in the linings of the gastrointestinal tract particularly in the throat, esophagus and stomach could lead to bleeding. Inflammation of the stomach lining (gastritis or gastroenteritis) could also produce blood that could make its way towards the oral region. Severe causes include viral hemorrhagic fever (profuse bleeding, fever, shock, and diarrhea) and tumors in the gastrointestinal tract.
Severe weight loss, followed by chills, fever and frequent coughing of blood could be caused by tuberculosis, lung cancer or bleeding in the airway particularly if the patient is exposed to risk-factors like smoking and airborne particulates. Severe physical injuries could lead to internal haemorrhaging which may result in coughing up blood. Some cardiovascular conditions, for example mitral stenosis can lead to hemoptysis accompanied by chest pain and palpitation. Autoimmune disorders like Hughes-Stovin syndrome, Wegener’s granulomatosis and Goodpasture’s syndrome are uncommon but severe causes of hemoptysis.
Lower respiratory infections, like bronchitis and pneumonia, are common causes of hemoptysis. Pneumonia itself is caused by either infections (infection pneumonia) or irritation in the lungs (aspiration pneumonia), causing the lungs to become inflamed due to alveoli (airs sac) irritation and fluid filling the air spaces. Bacterial infections leading to pneumonia include infection by Streptococcus and Staphylococcus strains, Myobacterium bacillus (tuberculosis), and Legionella pneumophila (Legionnaires’ disease). Viruses (influenza virus, respiratory synctial virus and herpes simplex) as well as fungi (Histoplasma, Coccidioides, Blastomyces, and Pneumocystis) can also cause pneumonia. These infections usually occur in persons with compromised immune systems, perhaps due to other ailments, weather and environment, or exposure to irritants.
A compromised immune system coupled with smoking, occupational exposure to pollutants and viral agents (adenoviruses, influenza viruses, and rhinoviruses) could lead to bronchitis or bronchial inflammation. Infections, cancer and diseases of the bronchi are the primary causes of coughing up blood in industrialized countries. Irritation of airways, as well as nasal passages could also lead to the presence of blood when coughing.
Infections are usually treated with the specific antibiotic for the specific microorganism. Self-medication, particularly of antibiotics for undetermined hemoptysis is particularly discouraged due to the risk of building up resistance in non-target pathogens. Proper nutrition and avoidance of risk factors like exposure to particulates and smoking can prevent and alleviate infections in the respiratory tract. Boosting one’s immune system thru vitamins and rest could prevent chronic respiratory infections.
For massive or frequent coughing of blood, a doctor’s immediate treatment is essential. The risk of blood loss or of blood filling the alveoli is great in massive hematesis and hemoptysis, respectively, thus no delay should be made in obtaining medical assistance. Obtaining aid is vital in cases of fainting or weakness.
In cases of where one coughs up blood, a doctor’s accurate assessment of the root cause is required. However, patients themselves can aid in the diagnosis by noting down time, frequency, amount and visual characteristics. These observations would greatly aid in identifying the source of the blood and the subsequent cause. Taking note of other symptoms that accompany these episodes would help the physician accurately diagnose and treat the root cause.
Coughing up blood certainly is a frightening experience. But by staying calm and being aware of the causes, one can obtain a fair assessment of the severity, as well as gain insight on the appropriate steps to take in order to facilitate treatment.[ad#afterpost]
- Bond D, V. H. ( 2001). Viral pneumonia and hemoptysis. Crit Care Med , 29(10):2040–1.
- Corder, R. (2003). Hemoptysis. Emergency Medical Clinics of North America , 21, 421-435.
- Overton, D. (2006). Gastrointestinal bleeding. In K. G. Tintinalli JE (Ed.), Emergency Medicine: A Comprehensive Study Guid. McGraw, Hill
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