Coughing Up Blood (Hemoptysis)

Coughing up blood from the lower respiratory tract, which is known as hemoptysis, can be a distressing symptom. But it’s important to understand that there are many reasons for this symptom besides serious illnesses like cancer.

Hemoptysis should be discussed with a healthcare provider if experienced. It can be life-threatening if large amounts of blood are being coughed up.  

This article focuses on the symptom of coughing up blood, its potential causes, and when to seek tests and treatment. 

Symptoms of Hemoptysis

The amount of blood that is coughed up can vary from blood-tinged sputum (saliva and mucus) to large amounts of blood. Although blood volumes vary within categories, there are three general ways to classify the amount of blood, as follows:

• Scant hemoptysis: A small amount of blood is seen in the sputum, which appears as pink or with small streaks.
• Mild to moderate hemoptysis: Blood volume averages less than 100 milliliters (a little less than one-half cup) of blood but is more than a streak.
• Massive hemoptysis: At least 100–1,000 milliliters (up to about 1 quart) of blood is coughed up within 24 hours.

Causes of Hemoptysis

Hemoptysis is blood that comes from a source in the lower airway (beneath the vocal cords). Sometimes you may experience pseudohemoptysis, in which the blood being coughed up comes from the mouth or other areas above the vocal cords, such as the nose.

In most cases of hemoptysis, no exact cause is ever found. However, documented cases have revealed that the most common causes of hemoptysis are:

• Infection: such as pneumonia (infection of the lung), bronchitis, fungal infection, or tuberculosis
• Cancer
• Pulmonary embolism (PE): A blood clot that lodges in the lung

Hemoptysis can occur from the blood vessels in the lungs. These blood vessels can be under different levels of pressure as the blood moves through them. Some of the blood vessels are quite thin. An infection or other inflammation may cause the blood vessel to leak. This leak results in bleeding, which may then be coughed up.

A similar process may occur when a tumor is growing in the lung. The physical presence of the tumor may cause inflammation that affects the blood vessels in the lung. Or, the tumor may grow directly into the blood vessel itself, resulting in bleeding.

When a PE moves into an artery in the lung, it can cause an increase in pressure in the vessel that can lead to bleeding.

What Medications Can Cause Hemoptysis?

Hemoptysis can be more likely when people are on anticoagulants. These medications are commonly referred to as blood thinners, They may be given when people have had a blood clot or are at risk of getting one.

Examples of blood thinning medications include:

• Coumadin (warfarin)
• Eliquis (apixaban)
• Plavix (clopidogrel)
• Xarelto (rivaroxaban)
  

When people take these medications, they have a higher risk of bleeding. This bleeding can include hemoptysis. 

How to Treat Hemoptysis

If you cough up blood, notify your healthcare provider for next steps. Hemoptysis should not be treated at home without notifying a healthcare provider. 

The exact treatment for coughing up blood is based on the cause of the bleeding and can consist of medications as well as procedures. 

Medications

If hemoptysis is caused by an infection or inflammation, treating it with the appropriate antibiotics or anti-inflammatory medications can resolve the infection and stop the bleeding.

If coughing up blood is caused by cancer, treating the cancer can help to stop the bleeding. Lung cancer may be treated with surgery, radiation, chemotherapy, immunotherapy, targeted therapy, or a combination of these.

When a PE is causing bleeding, treatment can be more complicated, as the treatment for a PE is giving a blood-thinning medication. This could put someone at risk for more bleeding.

If the cause of hemoptysis is blood-thinning medications, holding of on taking anticoagulants for a period of time may be the treatment that is recommended.

Procedures

If someone has a lot of blood loss through hemoptysis, procedures can be done to stop the bleeding, including the following: 

Bronchoscopy: During bronchoscopy, a scope is placed into the lungs. Liquid blood can be suctioned out of the airways, and clots can be carefully removed. This procedure can also allow the healthcare provider to look for the source of the bleeding and perform procedures to stop it.

During a bronchoscopy, a balloon can be inserted and inflated to put pressure against the area of bleeding in order to stop it. Cold saline (a saltwater solution) also can be infused into the airways to help shrink the size of bleeding blood vessels. In addition, laser treatment of the bleeding areas can be used to stop the bleeding.

Bronchial artery embolization: During this procedure, imaging tests will locate the artery in the lung that is bleeding. Once the bleeding artery is found, it can be embolized (blocked off) to stop the bleeding.

Surgery: Surgery may be able to stop the bleeding by removing the cause of it, such as a tumor, or repairing or removing organs, such as with a pulmonary resection, which is removal of all or part of a lung. Surgery may be needed when other interventions have not worked.

Complications and Risk Factors Associated With Hemoptysis 

Coughing up blood can be a potentially life-threatening symptom, especially if the bleeding is massive. It can prevent the lungs from being able to oxygenate normally, reducing the amount of oxygen in the body. The decreased oxygen can put stress on the heart and other organs, which can lead to serious complications.

Are There Tests to Diagnose the Cause of Hemoptysis?

To determine what may be the cause of coughing up blood, the healthcare provider may order one or more of these tests to find the cause:

• Physical examination
• Laboratory tests (blood counts, coagulation studies)
• Chest X-ray
• Computed tomography (CT) scan
• Bronchoscopy

When to See a Healthcare Provider 

You should see a healthcare provider any time coughing up blood is experienced. If the bleeding is very light and is not severe, this may not be an emergency but does require a call to the healthcare provider quickly. 

If there are large amounts of bleeding present, call 911 immediately or go to the nearest emergency room. 

Summary

Hemoptysis, or coughing up blood, is a symptom due to several causes. These include infection, cancer, and pulmonary embolism. A physical exam, imaging studies, and procedures such as bronchoscopy may be done to find the source of the bleeding.

Treating hemoptysis depends upon the source and can include medications or procedures to stop the bleeding. 

A Word From Verywell

Many people think that if they experience coughing up blood, they have lung cancer. Most causes of coughing up blood are never found, however, and infection is more likely than cancer. Report signs of coughing up blood to your healthcare team immediately to find out what’s causing it.