When is coughing up blood an emergency?

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Coughing up blood, also known as hemoptysis, can be very scary. It can also be confusing at first. Is the blood really coming from the lungs or could it be bleeding from the nose, esophagus , or stomach? Although hemoptysis is the most specific symptom of lung cancer, it is more likely to occur from a benign cause .

Let's take a look at the possible causes, what can be done to diagnose the underlying problem, and possible treatment options. We will also discuss when coughing up blood can be urgent, but coughing up even a small amount of blood can be dangerous .

When you cough up a third of a glass of blood, the death rate is about 30%. If you've coughed up a teaspoon of blood, don't wait to make an appointment. Call 911 now.

Symptoms

Hemoptysis can occur when there is bleeding in the throat, windpipe , or large or small airways in the lungs ( bronchi or bronchioles ). Many people describe their symptoms as spitting up mucus with streaks of blood. When coughing, blood often mixes with phlegm and can appear bubbly.

It is important to distinguish between coughing up blood and blood that comes out of the mouth from other parts of the body. "Pseudohemoptysis" is a term that describes regurgitation of blood that does not come from the lungs or bronchi. Hematemesis is a term that refers to blood that comes from the esophagus and stomach (blood that ejaculates) .

Causes

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Coughing up blood does not necessarily mean that you have lung cancer. This symptom can be caused by many conditions and only one of them is lung cancer . But since the prognosis for lung cancer is better the earlier it is diagnosed, it is important to consult with your doctor as soon as possible.

Hemoptysis is the only symptom in only 7% of people diagnosed with lung cancer and is considered the most specific symptom of the diagnosis.

The most common causes of coughing up blood are respiratory irritation from coughing or infection. Some possible causes of sputum with streaks of blood include :

  • Inflammation and irritation of the respiratory tract from repeated coughing.
  • Bronchitis
  • Bronchiectasis
  • Lung cancer. About 20% of people with lung cancer experience hemoptysis at some point in the course of their disease, and breast cancer (including lung cancer) accounts for about 25% of hemoptysis cases .
  • Pneumonia
  • Pulmonary edema
  • Blood clots in the lungs ( pulmonary embolism ): With pulmonary embolism, people often experience pain, redness, or swelling in the calves due to a deep vein thrombosis.
  • Tuberculosis: is the most common cause of hemoptysis worldwide, but less common in the United States.
  • Inhalation of a foreign body
  • Blood clotting disorders: These can be inherited or caused by taking medications or supplements that increase the time it takes for blood to clot.

In children

Coughing up blood in children tends to have different causes than the same symptom in adults. The most common causes are infections such as pneumonia, bronchitis, and tuberculosis .

In about a third of cases, the cause cannot be determined and the symptom goes away without finding a cause (something called 'idiopathic. ” An underlying heart disease is the second most common cause of hemoptysis in children .

When to go to the hospital

Coughing up blood can quickly become an emergency. Coughing up more than a teaspoon of blood is considered a medical emergency. When you cough, 100 cubic centimeters (cubic centimeters) of blood, just 1/3 of a cup, is called massive hemoptysis, and the death rate (death rate) is over 50 percent. Do not try to drive the car yourself or let someone else drive it. you to the hospital – call 911.

You should also call emergency services immediately if you experience chest pain, shortness of breath, or dizziness, even if you are only coughing up traces of blood. The problem is that coughing up blood can quickly cause airway obstruction and aspiration of blood into the lungs.

Diagnostics

If you are coughing up blood, even a very small amount just one time, or even if you are not sure whether you actually coughed up blood, it is important to make an appointment with your doctor.

If possible, bring a sample of your cough to your doctor's appointment. Wrapping the sample in plastic wrap or wax paper can preserve the sample better than wrapping it in a cloth.

Exam

Your healthcare provider will ask you several questions in addition to a complete physical exam. Some of these include:

  • How long has this been going on?
  • When did it start?
  • Did this happen while you were eating?
  • How much blood have you coughed up?
  • Was the blood mixed with mucus?
  • What other symptoms did you experience? For example, persistent cough, allergy symptoms, shortness of breath, hoarseness, wheezing, unexplained weight loss, or fatigue.
  • Have you had choking episodes?
  • Have you ever smoked or smoked?
  • What medications are you taking (including herbal supplements or over-the-counter medications)?
  • What other illnesses do you have?
  • Has anyone in your family had bronchitis, bleeding disorders, lung problems, or lung cancer?

Depending on the amount of blood you are coughing up, your healthcare provider will first want to make sure your airways are in place to prevent aspiration (inhalation of the contents that is in your mouth) and to control any active bleeding.

Tests

Then your healthcare provider will recommend tests to determine the cause. Possible tests may include:

  • Laboratory tests to check blood counts and find causes of bleeding.
  • A chest X-ray to look for signs of swelling.
  • CT scan of your breast
  • Bronchoscopy to look for foreign bodies or evaluate the airways for swelling (in bronchoscopy, a flexible tube is inserted through the mouth and down into the bronchi)

If you are actively bleeding, CT is often the preferred imaging technique to assess the bleeding. Treatment will depend on the cause of your symptoms and the amount of blood you are coughing up. Remember that if you only cough up blood once, and even if it is a small amount, it is imperative that you see your doctor as soon as possible.

It is important to be your own advocate and to keep asking questions if the answer is not found. Lung cancer is often missed on a plain chest X-ray and more tests are needed, including a chest CT scan . If you don't get answers, consider a different opinion.

If your healthcare provider suspects you may have lung cancer, you can learn more about how lung cancer is diagnosed, what to expect, and your possible risk factors for lung cancer (this goes well beyond smoking and 10% to 15% of lung cancer cases). cancer cases). lung cancer is diagnosed in people who have never smoked).

Be wary of the possibility of lung cancer until a diagnosis is ruled out. Lung cancer occurs in nonsmokers. This happens in young people. And in women it is almost as common as in men.

Unfortunately, the average time between the onset of symptoms and the diagnosis of lung cancer is 12 months. – the time during which treatment can often affect the outcome of the disease.

Watch out

Finding and treating the underlying cause is an important step in the fight against hemoptysis, but sometimes a symptom needs to be treated directly (and immediately), even if the cause is not entirely clear.

The first step in treating hemoptysis is making sure your airways are protected. Intubation (insertion of an endotracheal tube) may be required, especially if there is massive bleeding. When bleeding is light, treatment can be directed at the underlying cause. Otherwise, you can consider the following options.

Bronchoscopic options

There are several techniques that can be used during bronchoscopy to stop bleeding, but they are most effective when the bleeding is light or moderate. Some options include:

  • Endobronchial inserts: Various substances can be injected endoscopically to try to stop the bleeding locally. Some of these include frozen saline, fibrinogen, and oxidized regenerative cellulose.
  • Coagulation by argon plasma coagulation or photocoagulation
  • Electrocoagulation (endobronchial)
  • Endobrochial stent (especially for lung cancer )

Bronchial artery embolization

With very significant bleeding (massive hemoptysis), bronchoscopic procedures are much less effective. Currently, embolization of the bronchial arteries is recommended as the first line of treatment for massive hemoptysis and can be quite effective (although the probability of success is greater if the cause is a diagnosis other than cancer).

In this procedure, a catheter is inserted into an artery in the upper thigh (femoral artery) and advanced to the pulmonary artery. Then, various substances, such as a gelatin sponge, PVC particles, or a metal coil, can be used to embolize the artery (clot formation) .

Operation

Surgery is required less often than in the past for hemoptysis, but it is still commonly used in situations such as massive hemoptysis due to trauma. Surgical intervention can be performed minimally invasively (video thoracoscopic approach) or openly. Most often, a wedge of lung tissue is excised in the area of the hemorrhage (sublobar resection).

Most of the bleeding in the airways comes from the bronchial arteries, and bronchial artery embolization (essentially injecting a clot into an artery) is usually an effective treatment.

Get the word of drug information

Coughing up blood can be a scary symptom, and causes can range from lungs, such as irritation of the airways from coughing, to serious ones, such as lung cancer or a blood clot in the lungs. Even light bleeding in the lungs can be dangerous due to the risk of aspiration (and suffocation). Coughing up just a teaspoon of blood is considered a medical emergency.

As scary as it is, even with active bleeding, a lot can be done. Bronchial artery embolization is often very effective in an otherwise life-threatening situation.

Although coughing up blood is the first symptom in only 7% of lung cancers, it is important to rule it out in adults regardless of risk factors. As with other cancers, the earlier lung cancer is diagnosed, the better the chance of a cure.

Frequently asked questions

  • Not Usually. On rare occasions, people cough up blood. According to some reports, 1% to 5% of people hospitalized for COVID suffer from this symptom. It has also been seen in people recovering from COVID-related pneumonia.

  • Blood can come from the nasal passages, throat, lungs, or airways, where blood vessels can rupture due to coughing or irritation. If your blood count is very low, this shouldn't be a problem, but tell your doctor to make sure it's not a more serious lung infection.

  • Yes. Blood thinners, also known as blood thinners, can sometimes cause you to cough up blood. These medications include Coumadin (warfarin), Xarelto (Rivaroxaban), and Pradaxa (Dabigatran). Call your doctor immediately if you feel it.

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