Pulmonary haemorrhage – causes, diagnosis, treatment

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Lung haemorrhage is a condition accompanying advanced respiratory diseases. In pulmonary haemorrhage, blood is excreted abundantly, fresh, foamy, and bright red in color. This type of haemorrhage usually occurs in patients with tuberculosis or cancer. In the event of pulmonary haemorrhage, urgent medical attention is required.

Characteristics of pulmonary hemorrhage

Pulmonary haemorrhage is bleeding from the respiratory tract exceeding 200 ml per day, which usually occurs in patients suffering from advanced respiratory diseases. Abundant bleeding is not only a direct threat to life, but also evokes a sense of fear in patients. The severity of bleeding is directly related to the size of the damaged vessel. Therefore, it is very important to recognize the symptoms as soon as possible and to start appropriate treatment. In emergency management, the bronchial tubes should be unblocked and the patient calm. Bronchoscopy is used to determine the cause and site of bleeding. During the procedure, you can also suck off any residual blood and remove clots and try to stop any bleeding from the lungs. Some patients require surgery.

Classification of pulmonary bleeding:

1. haemoptysis (the patient loses a small amount of blood),
2. severe bleeding (less than 150 ml of blood is lost per day),
3. pulmonary haemorrhage (the patient loses more than 600 ml of blood per day).

Lung haemorrhages – causes

The most common causes of pulmonary bleeding are the following conditions:

1. lung cancer (the most common cause of ailments),
2. lung abscess,
3. fungal infections,
4. bronchiectasis
5. cystic fibrosis,
6. the presence of a foreign body in the lungs,
7. tuberculosis,
8. pulmonary embolism,
9. pneumonia (the second very important cause of pulmonary hemorrhage),
10. bronchitis,
11. bronchial carcinoid,
12. bronchial adenoma,
13. fibrous-cavernous changes,
14. taking samples from the bronchi,
15. anticoagulant treatment,
16. complications after endobronchial treatment.

Lung cancer remains the most important cause of pulmonary hemorrhage. Haemorrhages can also appear as a result of the tumor spreading to adjacent tissues, e.g. the formation of a broncho-oesophageal fistula. Tumor hemorrhage may also be associated with various diagnostic procedures, e.g. after bronchoscopic examination of a specimen or puncture of the lung parenchyma through the chest wall. Moreover, the ailment may occur as a complication of a lung tumor, e.g. after surgery.

Less frequent causes of haemorrhage are lung metastases in the course of breast or laryngeal cancer. Recurrent bleeding occurs in people who have malignant mesothelioma. In addition, tuberculosis is considered a rare cause of respiratory bleeding, as its early detection and appropriate treatment reduce the number of cases.

Other causes of pulmonary haemorrhage related to circulatory disturbance include:

1. pulmonary congestion,
2. myocardial infarction,
3. defect of the mitral valve.

Pulmonary haemorrhage can also cause extrapulmonary causes, such as hypertension and thrombocytopenia.

Pulmonary haemorrhage – diagnosis

In most patients, pulmonary haemorrhage is associated with the course of the underlying disease. Sometimes, however, there are doubts as to the cause of the ailments, so a bronchofiberscopy test is performed. It aims to visualize the source of bleeding and allows the collection of material for mycological, histopathological and bacteriological examination. Imaging tests, including computed tomography and chest X-rays, are also helpful.

When differentiating pulmonary hemorrhage from other conditions, it is worth considering:

1. gastrointestinal bleeding
2. nasopharyngeal haemorrhage
3. bleeding in the mouth (varicose veins at the base of the tongue).

In some patients, a supplementary examination may also include an esophageal colonoscopy, ENT examination, and gastroscopy.

Lung hemorrhage – home help

First aid in home conditions consists of:

1. quickly calling a doctor,
2. placing the patient in a semi-sitting or sitting position (preferably in bed or in a comfortable armchair),
3. providing the patient with peace,
4. it is forbidden to speak,
5. a ban on smoking,
6. applying cold compresses to the area of ​​the breastbone and the anterior chest wall,
7. giving the patient to drink (in small sips) salt or cold water with ice,
8. administering oxygen in the case of pulmonary haemorrhage,
9. possible administration of drugs to inhibit the cough reflex.

Treatment of pulmonary hemorrhage

In all patients with pulmonary haemorrhage, causal treatment should be initiated after prior evaluation of the patient’s general condition. Not everyone can undergo surgery. In such situations, an alternative method is embolization of bleeding vessels or emergency pharmacological treatment (antibacterial, antifungal or antituberculosis preparations). Causal treatment in patients with advanced cancer is impossible because the disease is very advanced and the organ capacity is decreased. However, in this group of patients, radiotherapy or brachytherapy can be used as symptomatic treatment. Endobronchial brachytherapy is an effective method of treating inoperable lung cancer. Its main advantage is the ability to deliver a large dose of radiation to the affected area, sparing the surrounding healthy tissues. The duration of treatment with brachytherapy is short and the effect is quick. Treatment usually does not bring about side effects, but in a certain group of patients complications such as bronchial fistula may occur. The highly potent isotope of iridium is used in brachytherapy.

In hospital conditions, bronchoscopy is performed to help aspirate any residual blood and determine the place and cause of bleeding. Thanks to bronchoscopy, you can also try to stop the bleeding with a balloon or by coagulation of the vessel.

In chronic treatment, supporting preparations are recommended, e.g. hemostatic cyclonamine. This preparation seals blood vessels and significantly shortens the bleeding time. It is administered both orally and parenterally. Vitamin K (administered intramuscularly), necessary for the synthesis of prothrombin, also has a good effect in supportive therapy.

WARNING! Blood remaining in the bronchi can cause infections, so give the patient antibacterial preparations!

Thus, emergency management of pulmonary haemorrhage includes:

1. determining the cause and place of bleeding,
2. ensuring bronchial patency,
3. administration of antitussive drugs (codeine),
4. intravenous administration of 10% NaCl,
5. administration of vascular sealing drugs,
6. use of inhalation with the addition of epinephrine solution,
7. inhibition of hemoptysis.

It should be remembered that pulmonary hemorrhage accompanying another chronic disease is a very big problem. In any case, heavy bleeding should be promptly consulted with a doctor and treated appropriately. Thanks to the correct diagnosis, it is possible to undertake appropriate treatment. On the other hand, patients who are moribund should have bronchial patency and administer sedatives to improve their quality of life.