Hemoptysis (Coughing Up Blood)

What Is Hemoptysis (Coughing Up Blood)? Hemoptysis Causes and Treatment

Dr. Nazmi Demirtaş is specialist in the ward of chest diseases at the hospital Avicenna Ataşehir, answering all curious questions about coughing up blood, also known as Hemoptysis.

What Is Hemoptysis

People who have coughing up blood, encounter blood in their sputum, or experience situations such as bleeding in the mouth while sleeping at night wonder what hemoptysis is. Haemoptysis is caused by the opening of one of the veins in the airways to the bronchi. Haemoptysis can occur in almost any airway disease. Although coughing up blood sometimes can be seen in simpler diseases such as bronchitis, it can be seen in some serious diseases such as lung cancer, tuberculosis, pulmonary embolism (clot in the lungs), whose early diagnosis is significant.

Coughing Up Blood

Hemoptysis is usually the result of respiratory problems. Hemorrhage often occurs as a result of chronic bronchitis or bronchiectasis. On the other hand, causes such as tuberculosis, heart failure, bronchial problems, pneumonia, and a blood clot that may have formed in the lungs can also cause hemoptysis. People who experience bleeding in the saliva, bleeding in the mouth during sleep, bleeding from coughing or hemoptysis should see a doctor. Spitting blood is not something that should be neglected, as it can lead to grave consequences. Occasionally, shortness of breath called dyspnoea may occur as a result of a cough with blood. You need to seek medical help in cases such as coughing, shortness of breath, coughing up blood, or calling 112 if the condition is life-threatening.

What Is Hematemesis

Haemoptysis is often confused with blood coming from the mouth and nose and bleeding from the gastrointestinal tract called haematemesis. In the differential diagnosis, bleeding occurs during coughing, while bleeding from the mouth, nose, and throat is usually in the form of bleeding and comes with saliva. The following should be considered when distinguishing between hemoptysis and haematemesis. The blood from the hemoptysis is bright red and often frothy. In haematemesis, bleeding occurs when vomiting, it is the color of coffee grounds and has many particles. Haematemesis is usually caused by bleeding from a stomach or duodenal ulcer. Irritation of the stomach or esophagus can also lead to vomiting of blood. Liver disease can also cause haematemesis and bleeding from the mouth. Bleeding can also be seen in ruptures of the pharyngeal tube, which are often seen as a result of heavy vomiting or intense coughing as a result of excessive alcohol consumption. On the other hand, it is known that bleeding from the mouth is rarely observed due to cancer of the stomach or esophagus.

Massive Hemoptysis

One of the most significant problems in hemoptysis is undoubtedly the amount of incoming blood. Massive hemoptysis is defined as 100 ml (one cup of tea) or 600 ml (three cups) of blood per day. Because massive hemoptysis can be life-threatening, it should be monitored and treated immediately. Given that the total volume of a person’s lungs is about 500 cc, if the blood cannot be expelled and filled in the bronchi, this can lead to suffocation in own blood. There are two circulatory systems in the lungs, one is the circulation that supplies the lungs (bronchial) and the other is the circulatory system, which supplies blood that has reduced oxygen in the body and increased carbon dioxide in the lungs (lungs). Massive hemorrhages originate mainly from the bronchial system with high pressure.

Causes Of Hemoptysis

The most common causes of hemoptysis are acute bronchitis, chronic bronchitis, pneumonia, infections caused by tuberculosis, lung cancer, bronchiectasis. Infections cause hemoptysis in 50 to 70 percent of cases. Bacterial infections often cause hemoptysis. Viruses such as influenza and HIV (AIDS) can also be among the causes of hemoptysis. Chronic bronchitis can also cause recurrent hemoptysis several times a year. Lung cancer is responsible for about 20% of hemoptysis. One of the rare causes of hemoptysis a gynecological condition called endometriosis is also causing hemoptysis, bleeding can usually occur during menstruation. These hemorrhages are called catamenial hemoptysis. Some environmental factors, such as arsenic, asbestos, nickel, and ether, can also cause hemoptysis. Some parasitic infections can also cause hemoptysis when they affect the lungs. Vascular diseases such as clotting in the lungs, arteriovenous malformations, arterial aneurysms can also cause hemoptysis. Despite all types of tests, the cause of hemoptysis cannot be detected in approximately 10% of patients and this condition is called idiopathic (unexplained) hemoptysis.

Diagnostic methods

The most commonly used diagnostic methods for hemoptysis are sputum examination, direct chest X-ray, tomography, digital substrate angiography (DSA), and bronchoscopy. Direct chest X-rays have low sensitivity in detecting the causes of hemoptysis. For this reason, other diagnostic methods, especially tomography, are often needed. Tomography has a sensitivity ranging from 60% to 100%. The use of bother – tomography, and bronchoscopy in the assessment of hemoptysis significantly increases the frequency of diagnosis and is recommended. Bronchoscopy can examine the cause of hemoptysis, and sometimes, especially in massive hemoptysis, can stop the bleeding.

Treatment Of Hemoptysis

There are 3 main goals in the management of hemoptysis. The first is to prevent bleeding and filling of the bronchi, which makes it difficult to breathe, the second is to stop the bleeding, and the third is to treat the disease that causes hemoptysis. Only in this way can the correct treatment of hemoptysis be done. Hemoptysis is treated depending on the cause. Massive hemoptysis requires urgent intervention, which may require bronchoscopy, embolization (blockage of the bleeding vessel), and surgery. A patient with massive hemoptysis may need to be monitored in the intensive care unit with an interdisciplinary approach.


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