Haemoptysis (Coughing Up Blood)

• What is Haemoptysis (hemoptysis)?
• What causes it
• When to see a doctor about it
• Tests and Examinations

Haemoptysis (hemoptysis) is simply a medical term for coughing up blood. The blood can appear as flecks, streaks or can be quite massive in amount. Haemoptysis (hemoptysis) can be caused by many things, but it is important to make sure that the blood really is from the lungs and not from other structures like the nose or the gastro-intestinal system. If you ever cough up blood, it is important to see your doctor so that they can investigate the possible cause.

What is Haemoptysis (Hemoptysis)?

While it may seem simple enough, coughing up blood (also known as haemoptysis or hemoptysis) has a very specific definition as it means that the blood is coming from the lungs, below the vocal cords. Haemoptysis (hemoptysis) can result in coughing up blood as small flecks, streaks or even as a massive bleed. Sometimes it can accompany mucus or sputum. The image to the right is that of a microscopic stain of a sputum sample containing both epitheleal and blood cells. To make sure that it is really haemoptysis then other sources of the blood such as the nose, throat or the gastro-intestinal system have to be excluded.

What Causes Haemoptysis (Hemoptysis)

There are many different causes of haemoptysis (hemoptysis). Some of the causes are:

• The most common cause is an acute Infection, especially in exacerbations of Chronic Obstructive Pulmonary Disease (COPD), usually secondary to smoking
• Chronic bronchitis
• Bronchiectasis, where the blood often mixed with thick, smelly sputum
• Pulmonary embolism (a blood clot in the lungs)
• Lobar Pneumonia, usually described as having ‘rust coloured’ sputum
• Pulmonary oedema (fluid in the lungs): pink, frothy sputum secondary to heart conditions such as mitral stenosis or left ventricular failure
• Lung Cancer
• Tuberculosis
• Inhaled Foreign Body
• Rupture of a blood vessel after vigorous coughing

In about one quarter of cases, even after thorough investigation the cause of the bleeding is never found.

When to See a Doctor about Haemoptysis (Hemoptysis)

Many, if not all of the causes of haemoptysis (hemoptysis) require looking into by a doctor and there are many very serious conditions that can lead to it. If you ever have an episode of haemoptysis it is important to see your GP so that they can decide whether it is worth worrying about or not.

Tests and Examinations for Haemoptysis (Hemoptysis)

Your doctor will want to examine your heart and your lungs for any signs of diseases that can cause you to cough up blood. They will probably also want to look in your nose to make sure that the blood is not coming from there (it can sometimes be hard to tell!). They will also want to take your temperature, as a fever can be a sign of infection. Your doctor will usually want to do a chest x-ray and may want to do a CT or bronchoscopy (where a tube is inserted into the airway allowing the doctor to see what is inside) depending on how severe the haemoptysis is, or what they find after taking your history and doing an examination.

References

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2. Murtagh, J. General Practice (Third Edition). North Ryde, McGraw-Hill Australia, 2003.
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4. Weinberger SE. Cough and Hemoptysis [online]. Harrison’s Internal Medicine. Access Medicine, 2006. Available at URL: http://www.accessmedicine.com (last accessed: 31/08/06)
5. Young WF, Stava M. Hemoptysis [online] Tintinalli’s Emergency Medicine. Access Medicine, 2006. Available at URL: http://www.accessmedicine.com (last accessed: 31/08/06)