Coughing up blood

Coughing up blood is the spitting up of blood or bloody mucus from the lungs and throat (respiratory tract).

Hemoptysis is the medical term for coughing up blood from the respiratory tract.

Considerations
Coughing up blood is not the same as bleeding from the mouth, throat, or gastrointestinal tract.

Blood that comes up with a cough often looks bubbly because it is mixed with air and mucus. It is usually bright red, although it may be rust-colored. Sometimes the mucus may only contain streaks of blood.

Causes
A number of conditions, diseases, and medical tests may make you cough up blood, including:

• Blood clot in the lung
• Breathing blood into the lungs (pulmonary aspiration)
• Bronchoscopy with biopsy
• Bronchiectasis
• Bronchitis
• Cancer
• Cystic fibrosis
• Inflammation of the blood vessels in the lung (vasculitis)
• Injury to the arteries of the lungs
• Irritation of the throat from violent coughing (small amounts of blood)
• Pneumonia or other lung infections
• Pulmonary edema
• Systemic lupus erythematosus
• Tuberculosis

Home Care
Cough suppressants may help if this condition is due to throat irritation from violent coughing. However, cough suppressants may lead to airway blockages in some cases. Always check with your doctor before using them.

It is very important to note how long you cough up blood, and how much blood is mixed with the mucus. Contact your doctor any time you cough up blood, even if you do not have any other symptoms.

When to Contact a Medical Professional
Get medical help right away if you cough up blood and have:

• A cough that produces more than a few teaspoons of blood
• Blood in your urine or stools
• Chest pain
• Dizziness
• Fever
• Light-headedness
• Severe shortness of breath

What to expect at your health care provider's office
In an emergency case, your doctor will give you treatments to control your condition. The doctor will then ask you questions about your cough, such as:

• Type
• Are you coughing up large amounts of blood (massive hemoptysis)?
• Can you see blood when you cough up something?
• How many times have you coughed up blood?
• Is there blood-streaked mucus (phlegm)?
• Time pattern
• Did it begin suddenly?
• Has it increased recently?
• For how many weeks has the cough lasted?
• Is the cough worse at night?
• What other symptoms do you have?

The doctor will do a complete physical exam and check your chest and lungs. Tests that may be done include:

• Bronchoscopy, a test to view the airways
• Chest CT scan
• Chest x-ray
• Complete blood count
• Lung biopsy
• Lung scan
• Pulmonary arteriography
• Sputum culture and smear
• Test to see if the blood clots normally, such as PT or PTT

Alternative Names
Hemoptysis; Spitting up blood; Bloody sputum

References
Brown CA III. Hemoptysis. In: Marx JA, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice . 7th ed. Philadelphia, Pa: Mosby Elsevier; 2009:chap 31.

Update Date: 5/1/2011
Denis Hadjiliadis, MD, Assistant Professor of Medicine, Division of Pulmonary, Allergy and Critical Care, University of Pennsylvania, Philadelphia, PA. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.