Hemoptysis – causes, symptoms, diagnosis

Proven content

Hemoptysis, the blood content in the sputum, is a source of anxiety both in the patient and in his environment. The cause of occasional haemoptysis may be, for example, a rupture of a vessel in the oral mucosa. First of all, it should be determined whether the blood in the sputum comes from the respiratory system or the upper gastrointestinal tract.

Hemoptysis – definition

Hemoptysis is a pathological condition characterized by the coughing up of blood from the respiratory system. The amount of this blood can vary from trace amounts to the coughing up of a very large amount of pure blood. In almost 90% of adults, haemoptysis occurs most often in the course of pneumonia, tuberculosis or lung abscess. A distinction must be made between haemoptysis and bloody vomiting and pseudo-bleeding. True hemoptysis occurs when the patient develops foamy sputum and bright red blood. Pseudo-hemoptysis, on the other hand, is blood from the mouth or nasopharynx, which is eventually coughed up.

Based on the amount of blood, three degrees of hemoptysis can be distinguished:

1. haemoptysis – it is haemoptysis, for which it is typical to cough up less than 20 ml of blood per day. It is a trace amount of blood, and the sputum is only colored with it;
2. haemoptoe – haemoptysis, characterized by coughing up more than 20 ml of blood per day (but less than 200 ml); these are already considerable amounts of pure blood;
3. haemorrhagia – characterized by the coughing up of blood in amounts exceeding 200 ml of blood in a day or more than 600 ml in the blood in two days. Patients cough up large amounts of blood in quick succession.

The above division is of great importance in further proceedings and is helpful in selecting the appropriate type of treatment. However, it should be borne in mind that the volumetric assessment is not always reliable, as coughing up even trace amounts of blood may indicate a serious disease. Therefore, each such episode should be immediately consulted with a specialist and subjected to extensive diagnostics (usually hospitalization is necessary). First of all, check whether the blood observed in the sputum comes from the respiratory system, the mouth, the nasopharynx or the upper gastrointestinal tract, e.g. from a ruptured esophageal varice.

Causes and symptoms of hemoptysis

When looking for the causes of haemoptysis, the first thing to do is to rule out any extra-pulmonary sources of bleeding. There are cases where hemoptysis originating in the gastrointestinal tract is confused with hemoptysis coming from the respiratory system. However, there are some differences to find the likely source of the bleeding (e.g. blood color and pH).

Haemoptysis originates most often in the bronchi and trachea. Expectoration of sputum with an admixture of blood occurs when they are inflamed or neoplastic, for example in such ailments as: bronchiectasis, bronchial carcinoid tumor, lung cancer, acute bronchitis, chronic bronchitis, or Kaposi’s sarcoma. Haemoptysis may also be associated with an injury to the respiratory tract or a foreign body located within them. People with bronchiectasis develop a moist cough, especially when lying down. In addition, there are shortness of breath, rapid fatigue, weight loss and deformation of the fingers.

Blood contained in sputum from respiratory organ, is usually accompanied by a nagging cough, and the sputum itself is bright red in color and may be more or less foamy as a result of mixing with air in the respiratory tract.

Blood from esophagus, or even stomach, is often accompanied by nausea, as well as retching, of which there is usually more: some may be brown as a result of gastric digestion.

Occasional blood in the sputum (eg in the form of red “ribbons” of blood) can be caused by a simple rupture of a vessel in the oral mucosa, in the bronchial tree, or in bronchiectasis due to persistent coughing.

Sputum in the blood may occasionally contain a rusty brown color chronic left ventricular failure and congestive congestion in the respiratory organ. The secretion that seeps into the bronchial tree at that time may trigger a cough reflex (the so-called cardiac cough), during which a blood vessel may rupture and stain the sputum with blood.

More pronounced and longer-lasting haemoptysis requires medical advice and careful examination, especially of the respiratory organ and the blood coagulation system, as hemoptysis may be, among others, a symptom of pulmonary tuberculosis, cancer of the respiratory organ, pulmonary infarction, lung abscess, aneurysms in the respiratory tract or a haemorrhagic diathesis (i.e. blood clotting disorders).

Some medications you are taking can also cause hemoptysis. These include, among others, anticoagulants in the form of heparin, acetylsalicylic acid and fibrinolytic drugs. Cocaine addicts also spit blood.

Hemoptysis on a nature idiopathic it occurs in up to 30% of patients. Its cause cannot be found. Probably hemoptysis is associated with small changes in the bronchi, which, despite the diagnostics carried out, remain undetected.

Other rare causes of hemoptysis:

1. platelet hemorrhagic diathesis,
2. plasma hemorrhagic diathesis,
3. diabetes,
4. vitamin K deficiency in the body,
5. vitamin C deficiency in the body,
6. hypertension.

Hemoptysis – diagnosis

The test that is performed most frequently in the case of haemoptysis is Chest X-ray. They are performed to detect possible more serious lesions, e.g. lung inflammation or a lung tumor. Another imaging test used in diagnostics is also computed tomography of the chestwhich, unlike the X-ray examination, is characterized by greater sensitivity and specificity. To accurately locate the bleeding site is performed bronchofiberoscopy, which also highlights the abnormalities located inside the bronchial lumen. In turn, with massive hemoptysis, it is performed stiff bronchoscopythanks to which it is possible to better control the airways. In addition to the above-mentioned methods, it is also applicable blur and seeds sputum material collected. These tests are aimed at the diagnosis of infections with bacteria and mycobacteria tuberculosis.

Hemoptysis – home pre-medical aid

Home pre-medical help in hemoptysis depends largely on its intensity and duration.

People with hemoptysis should:

1. take a comfortable, quiet position, half-sitting or sitting in bed,
2. stop taking warm fluids or other meals,
3. drink cold water in small sips or with salt and ice cubes,
4. in the case of abundant hemoptysis, apply a cold compress to the chest, especially on the area where there is pain or the impression of retention of discharge in the bronchial tree,
5. urgently call an ambulance.

Treatment of hemoptysis

With massive haemoptysis, it is necessary to take care of proper gas exchange and prevent blood from flooding unoccupied fragments of the pulmonary parenchyma. In patients with known unilateral bleeding, it is necessary to lay it on this side so that blood does not enter the opposite lung. Doctors wanting to stop hemoptysis use a variety of methods, including:

1. arteriography in the form of embolization of the bronchial artery
2. bronchoscopy
3. coagulation techniques
4. surgical resection of the affected lung fragment