Hemoptysis is coughing up of blood from lungs and other organs of respiratory tract such as bronchi and trachea. The severity of hemoptysis can vary from slight blood streaked sputum to life threatening frank massive hemorrhage. Blood in hemoptysis is bright red and slightly frothy. It is frothy because the blood is often mixed with air and mucus from respiratory tract.
Causes of Hemoptysis
Coughing up of blood is quiet frightening for the patient, although the cause in majority of patients is not serious. Often minor illnesses such as viral bronchitis can cause irritation and injury to the tiny blood vessel in respiratory tract causing bleeding. Sometimes bleeding from nose (post nasal drip) and throat can be coughed up as red sputum, however this is not hemoptysis.
- Bronchitis: It is inflammation of bronchi which is majorly caused by viral infection. Recurrent coughing in bronchitis causes breakdown of tiny blood vessels in the mucus lining of the air passage leading to coughing up of blood. In most cases bronchitis hemoptysis appears as blood streaked sputum. Sometime secondary bacterial infection may be present.
- Pneumonia: It is a lung infection caused either by bacteria or virus. People with weak immune system are more prone to develop pneumonia. In addition to hemoptysis, fever, constant cough, chest pain, lack of appetite are other accompanying symptoms of this disease.
- Tuberculosis: This lung disease is caused by a type of bacteria called mycobacterium tuberculosis. The bacteria can damage and destroy tissue of lung by forming cavities in lung. The blood vessel in lung can bleed causing hemoptysis.
- Lung cancer: Although rare cancer of lung can cause moderate to massive hemoptysis.
- Bronchiectasis: It is chronic disease of airways. In this condition the bronchi remain dilated constantly. Subsequent infection can further damage the supportive tissue causing coughing up of blood.
- Foreign body injury: This is common in children. A inhaled foreign body may damage the air passage leading to hemoptysis.
- Smoking: Smoking increases the risk of hemoptysis.
- Lung abscess
There are several other causes that may produce hemoptysis. These causes are other than lung diseases. For example cardiac causes such as aneurysm of aorta, mitral stenosis, pulmonary hypertension. Bleeding disorders can also cause hemoptysis. Condition such as thrombocytopenic purpura, leukemia, hemophilia, can cause bleeding and coughing up of blood from respiratory tract.
Usually hemoptysis in majority of cases is scanty and it spontaneously stops. The most important thing is to reassure the person because the sight of blood will make him anxious and nervous. Person must take complete rest as this will also help to reduce hemoptysis. Besides rest, patient may need mild sedation, proper hydration and nourishment. If at all the doctor suspects aspirated pneumonia, he will prescribe antibiotics. The underlying cause is addressed. For example if the cause is tuberculosis, appropriate anti tuberculosis medicine is started. In case of pneumonia, broad spectrum antibiotic medicine is started. Cough suppressant is prescribed to stop cough.
In case if hemoptysis is massive it becomes an emergency and patient need to be hospitalized for further care and treatment. In such cases person is in shock, his blood pressure is low, his body is cold and clammy, he has breathing trouble and pulse is weak. Patient is treated vigorously. Blood transfusion may be necessary to increase blood volume. Till proper matching blood is available, intravenous fluid is started. Once the massive coughing of blood is stopped, the doctor will search for the underlying cause and start the treatment accordingly.