Coughing up blood: what it can be, causes, treatment

general information

Hemoptysis from the respiratory tract is called hemoptysis. The amount of blood secreted can range from a few streaks of blood mixed with normal phlegm to large quantities of pure blood. Other symptoms, such as fever and shortness of breath, may be present depending on the cause of the hemoptysis.

Causes of coughing up blood

While coughing up blood can be frightening, most of the causes are not serious. Blood-streaked sputum is common in many minor respiratory conditions, such as upper respiratory tract infections and viral bronchitis. Sometimes the cause is blood from the nose, which runs down the throat and then is coughed up. This bleeding is not considered hemoptysis.

- Common causes of coughing up blood.

The most common cause is infection. In adults, 70 to 90% of cases are caused by:

• bronchitis;
• bronchiectasis - pathological irreversible expansion of part of the respiratory tubes or airways (the so-called bronchi);
• pneumonia.

In children, common causes include:

• lower respiratory tract infections;
• a foreign body that has been inhaled.

- Less common causes of coughing up blood.

Lungs' cancerwhich starts in the lungs is an important cause in smokers over 40. However, cancer that has spread to the lungs from other parts of the body rarely causes hemoptysis. Fungal infections caused by a microorganism Aspergillus (so-called "aspergillosis") Are increasingly identified as a cause, but not as often as cancer. Possible cause is pulmonary tuberculosis.

Other causes include a blood clot in an artery in the lung (pulmonary embolism) and, less often, inflammation of the blood vessels (vasculitis) in the lungs, such as Goodpasture's syndrome or granulomatosis with polyangiitis.

- Massive hemoptysis.

Massive hemoptysis is the discharge of more than 600 milliliters of blood in 24 hours. The most common reasons include the following:

• lung cancer;
• bronchiectasis;
• some types of pneumonia, including tuberculosis.

Risk factors

Some conditions increase the risk that hemoptysis is due to a serious medical condition:

• human immunodeficiency virus (HIV) infection (for Kaposi's sarcomas, tuberculosis and fungal infections);
• the use of drugs that suppress the immune system, the so-called immunosuppressants (for tuberculosis and fungal infections);
• exposure to tuberculosis;
• history of long-term smoking (for cancer);
• recent bed rest or surgery, cancer, recent episode or family history of any disorder blood clotting, pregnancy, use of medications that contain estrogen, and recent long-distance travel (for pulmonary embolism arteries).

Diagnostics

The following information can help you decide if you need to see a doctor and what to expect when you see a doctor.

- Warning signs.

In people with hemoptysis, the following symptoms are of particular concern:

• a large amount of coughing up blood;
• dyspnea (dyspnea);
• signs of significant blood loss (weakness, dizziness when standing up, thirst, sweating, and heart palpitations);
• weakness or fatigue;
• the presence of a tracheostomy.

- When to see a doctor?

People with warning signs should go to the hospital immediately. People without warning signs who have risk factors for serious illness, and people who have which, in addition to sputum streaked with blood, have other signs, you should consult a doctor within one or two days.

If people only have blood-streaked sputum (usually caused by an upper respiratory infection), a doctor's examination is not very urgent. People can call a doctor, who can decide if and how urgently they need testing based on symptoms, medical history, and other factors. Generally, a delay of a few days or so is not harmful.

- What does the doctor do?

Doctors first ask about symptoms and take a history, and then do a physical examination. Medical records and physical examination can indicate the possible cause of the illness and determine the necessary investigations.

Doctors ask:

• When a man began to cough up blood.
• How long does the cough last?
• Whether it was caused by something specific (such as cold, exercise, or lying down).
• How much blood is being coughing up (for example, streaks, teaspoon, or cup).
• Whether the person has other symptoms, such as fever, weight loss, chest pain, or leg pain.

Doctors determine if blood is actually being coughing up (rather than coming from vomiting or flowing blood down the back of the throat from nosebleeds).

Doctors ask patients about their medical history (if not already known) and risk factors to establish causes. A history of frequent nosebleeds, minor bruises, or liver disease indicates a possible clotting disorder. Doctors look at the drugs a person is taking to identify drugs that inhibit clotting (anticoagulants).

During the physical examination, doctors examine vital signs to detect an increase in body temperature. an increase in heart rate or breathing, and tests are performed to detect low oxygen levels in blood. Doctors do a complete exam of the heart and lungs, examine the cervical veins for signs of congestion such as bulging, and examine the legs for signs of swelling. Swelling in one leg may indicate the presence of a blood clot (deep vein thrombosis). Swelling in both legs may indicate heart failure. Doctors also examine the abdomen, skin, and mucous membranes. The person is asked to cough during the examination. If blood is coughing up, the doctor notes the color and amount of blood. Doctors also examine the nose and mouth for bleeding spots.

Key medical history findings and test results help doctors determine the cause. A feeling of post-nasal drip or any nosebleed, especially without a cough, may mean that the expectorated blood was coming down the back of the throat from the nose. The appearance of black, brown, or coffee-colored material during nausea and vomiting usually means that the blood is from the stomach or intestines and is being vomited and not coughing up. Foamy sputum, bright red blood and, when massive, a choking sensation usually indicates that the source of the blood is the trachea or lungs (called true hemoptysis).

If the cough has just begun, and if the person is otherwise healthy and does not have risk factors for developing tuberculosis, fungal pulmonary artery infection or thromboembolism, it is usually caused by an acute respiratory infection, such as bronchitis. If hemoptysis is caused lung disease or heart, the person has almost always been diagnosed with this heart or lung disease. That is, hemoptysis is usually not the first symptom. heart disease or lungs.

- Carrying out analyzes.

If haemoptysis is severe, chronic, or unexplained, an examination is necessary. If people cough up massive amounts of blood, then they receive treatment before being examined and their condition is stabilized.

A chest x-ray is a common procedure. If there are abnormalities in the chest x-ray, or if the person has symptoms or risk factors for a particular disorder, has a computed tomography (CT) scan, and bronchoscopy. In bronchoscopy, a flexible probe with an optical system is inserted into the trachea and bronchi to detect the site of bleeding. Sometimes bronchoscopy is needed to confirm that blood is being coughing up from the lower respiratory tract and not from the nose, stomach, or intestines.

If pulmonary embolism is suspected, doctors do a CT scan using a radiopaque contrast agent to visualize blood vessels (called "CT angiography"), or scanning with a radioactive marker (called "perfusion scintigraphy lungs "). Depending on the results of this scan, pulmonary angiography may be done.

Doctors often look for lung cancer, especially in smokers over 40 (and even younger smokers if they started smoking in adolescence), even if the sputum is only streaked blood.

To detect blood clotting problems, most people have a complete blood count and blood tests to evaluate the blood's ability to clot.

Despite the surveys, the cause of hemoptysis is not determined in 30-40% of people. However, if hemoptysis is severe, the cause is usually determined.

Treatment

Bleeding can lead to the formation of blood clots that block the airways and cause further breathing problems. Thus, coughing is important for keeping the airways clear and should not be suppressed by cough suppressants (antitussives).

Hemoptysis can be mild and may stop on its own or if a medical condition that is causing the bleeding (for example, heart failure or infection) is successfully treated.

If a large blood clot is blocking the main airways, doctors may be forced to remove the clot using bronchoscopy.

In rare cases, hemoptysis is severe or does not stop without intervention. In this case, a tube may need to be inserted through the mouth or nose into the trachea, or down into the airway to help keep the airway open.

If a large blood vessel is the source of the bleeding, the doctor may try to block the bleeding vessel with a procedure called bronchial embolization arteriography. Using X-rays to monitor actions, the doctor inserts a catheter into the vessel and then injects a chemical compound, fragments of a gelatinous sponge or a wire coil to block a blood vessel and thereby stop bleeding. Sometimes bronchoscopy or surgery is required to stop a severe or prolonged bleeding or surgery may be required to remove the affected or cancerous part lungs. These high-risk procedures are used only as a last resort.

If a blood clotting disorder is causing bleeding, the person may need a transfusion of plasma, clotting factors, or platelets.