Haemoptysis is the most common symptom of the disease, therefore the causes of this condition are varied. Spitting blood in adults may indicate many serious diseases, such as lung cancer or pulmonary embolism. On the other hand, haemoptysis in children is most often suggested by a foreign body in the respiratory tract. Find out what hemoptysis means.

Hemoptysisis the coughing up of blood or bloody sputum from the respiratory tract.Spitting bloodis usually a symptom of the disease ,therefore the causes of this condition are varied. In some cases, the cause of hemoptysis cannot be determined - this is calledcryptogenic hemoptysis .

It should be noted that the number of diseases manifested by hemoptysis exceeds 100.

Haemoptysis - causes

In 70-90 percent cases in adults, hemoptysis occurs in the course of such diseases as:

  • bronchitis
  • bronchiectasis
  • tuberculosis
  • pneumonia
  • lung abscess

In turn, lower respiratory tract infection and a foreign body in the respiratory tract are the most common causes of haemoptysis in children.

Primary lung cancer is a significant cause of hemoptysis in smokers over 40 years of age. Symptoms of haemoptysis in lung cancer occur in about 1/3 of patients, usually with a significant advancement of the disease process. However, metastatic cancer is a cause only sporadically.

The underlying cause of hemoptysis, but not as common as neoplastic diseases, is an infection with a fungus of the speciesAspergillus .

Hemoptysis should be distinguished from bloody vomiting and the so-called pseudo-bleeding.True haemoptysisis diagnosed when there is foamy sputum, bright red blood and, in the case of massive bleeding, a choking sensation.

In turn,pseudoptysisis blood from the nasopharynx or mouth, which eventually becomes coughing up.

A feeling of "dripping" from the back nostrils, or overt epistaxis without coughing, indicate this type of haemoptysis. Pseudo haemoptysis may also apply to diseases related to the upper gastrointestinal tract.

On the other hand, nausea and vomiting with black, brown or coffee grounds are characteristic of of bloody vomiting , related to diseases of the lower gastrointestinal tract.

Haemoptysis - pathomechanism

Most of the blood (95%) flows through the lungs through low-pressure pulmonary arteries and reaches the capillary bed, where gas exchange takes place.

Only around 5 percent it flows through the high-pressure bronchial arteries that begin in the aorta and end in the main airways and supporting structures. In most cases of hemoptysis, blood comes from this bronchial bed.

Haemoptysis (spitting blood) - diseases of the trachea and bronchi

  • cancer(bronchial carcinoma, lung cancer, metastases of neoplasms of other organs, Kaposi's sarcoma), apart from hemoptysis, is usually manifested by night sweats, weight loss, as well as shortness of breath, persistent cough and chest pains
  • bronchitis-the acute form is manifested by a moist or dry cough, as well as initially mucous (white), then purulent (yellow) sputum, burning sensation and chest pain and wheezing when breathing in and out. In chronic bronchitis, a wet cough with expectoration (mainly occurring in the morning) lasts most days of the year, or for 3 months a year for the next 2 years in people with COPD or a history of smoking
  • bronchiectasismanifests itself with a chronic moist cough that worsens when lying down, thick mucus with an unpleasant odor, shortness of breath and wheezing. In addition, there are symptoms such as weight loss, easy fatigue, weakness of the body and deformation of the fingers (the so-called club fingers)
  • bronchial calculimanifests as a calcified lymph node in patients with a history of granulomatous disease

Haemoptysis may also indicate a foreign body in the airways, resulting in a chronic cough (usually in an infant or toddler) without signs of an upper respiratory tract infection. Only occasionally a fever may appear.

Important

Hemoptysis - when to see a doctor immediately? Alarming symptoms

See your doctor as soon as possible if you experience massive haemoptysis or haemoptysis along with: back pain, feeling crushed, weight loss or fatigue, shortness of breath at rest, and no or less respiratory sounds.

Haemoptysis (spitting blood) - diseases of the interstitial lung tissue

  • lung abscessis manifested by subacute fever, cough with expectorationa large amount of purulent sputum, night sweats, lack of appetite, weight loss, as well as a characteristic eardrum in the percussion test
  • pneumoniais characterized by fever, a moist cough, shortness of breath, chest pain, and a lowering of respiratory sounds and their nature (pronounced "e" heard as "a"). In addition, leukocytosis is diagnosed - an increased number of white blood cells
  • active granulomatous diseases(tuberculosis, pulmonary mycosis, parasitosis, syphilis) or mycetoma - fever, cough, night sweats and weight loss are characteristic symptoms. Often the accompanying symptom is immunodeficiency
  • Goodpasture's syndromecharacterized by flu-like symptoms, fatigue, weight loss, gastrointestinal symptoms (nausea, vomiting, diarrhea), often haematuria (resulting from kidney failure) and sometimes swelling of the body
  • Wegener's granulomatosis ( granulomatosiswith polyangiitis)usually presents with chronic, bloody runny nose and nasal ulceration. Joint pains and skin changes (papules, purpura) often appear. In addition, the patient may complain of gingivitis or gingivitis. The characteristic symptom is the saddle nose, perforation of the nasal septum. Sometimes it may lead to kidney failure
  • lupus pneumoniacan be identified by fever, cough, shortness of breath, and chest pain in patients diagnosed with SLE (systemic lupus erythematosus)

Haemoptysis can also be the result of a lung injury, incl. after examinations, e.g. bronchoscopy, i.e. endoscopic examination of the respiratory tract or lung biopsy.

Important

Massive hemoptysis - what does it mean?

Massive hemoptysis is coughing up more than 600 ml of blood (the volume of a single hospital kidney) in 24 hours. Most often it indicates bronchial cancer, bronchiectasis or pneumonia of tuberculous or other etiology.

In the event of massive haemoptysis, and the source of the bleeding is unknown, place the patient with the bleeding side down.

Haemoptysis (spitting blood) - cardiological diseases

  • pulmonary embolismis characterized by shortness of breath, chest pain, rapid breathing and heart rate, and coughing. The sick are often accompanied by a feeling of fear and anxiety. Some patients may experience hemoptysis, fainting and even shock
  • left ventricular failure -dyspnoea is a characteristic symptom. In the initial stage, it only accompaniesphysical exertion and subsides after its completion. This is followed by dyspnea at rest, which can also occur at night (paroxysmal nocturnal dyspnea). As the disease progresses, systolic blood pressure drops and cyanosis and cough appear (possible coughing up of blood-colored foamy discharge). The main symptom of acute left ventricular failure is pulmonary edema
  • stenosis of the mitral (mitral) valvemanifested by decreased exercise tolerance, fatigue, exercise dyspnea, cough at night (often with blood-stained sputum)
  • pulmonary hypertensioncan be identified by shortness of breath, a feeling of lack of air, shortness of breath especially during exercise. As the disease progresses, exhaustion, dizziness, fainting, chest tightness or pain, swelling of the ankles or legs appear

Haemoptysis (spitting blood) - drugs

Drugs with side effects of hemoptysis include:

  • anticoagulants (heparin, acenocoumarol)
  • thrombolytic drugs
  • acetylsalicylic acid

Taking cocaine may also contribute to spitting blood.

Haemoptysis (spitting blood) - rare causes

The list of rare causes of hemoptysis includes:

  • plasma and platelet bleeding (including thrombocytopenia)
  • hypertension
  • diabetes
  • vitamin C deficiency (scurvy)
  • vitamin K (diseases with significant liver damage)
About the authorMonika Majewska A journalist specializing in he alth issues, especially in the areas of medicine, he alth protection and he althy eating. Author of news, guides, interviews with experts and reports. Participant of the largest Polish National Medical Conference "Polish woman in Europe", organized by the "Journalists for He alth" Association, as well as specialist workshops and seminars for journalists organized by the Association.

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