Coughing with blood - causes, diseases, diagnosis and treatment

Hemoptysis - a frightening condition in which blood is periodically released along with sputum during coughing. In some cases, these are only bloody inclusions, while in others the blood completely stains the sputum. Based on the type and amount of blood impurities, one can roughly guess the source and cause of the bleeding, but delaying a visit to the doctor is unacceptable. In Anapa, the diagnosis and treatment of diseases that cause hemoptysis are dealt with in medicine.

Coughing up blood: causes of illness in adults

In some cases, when the cough is strong, dry and hysterical, a small amount of scarlet blood in the sputum may be the result of damage to small superficial vessels in the bronchi, pharynx or trachea. This phenomenon is not dangerous if it is not accompanied by other alarming signs. However, if the cough does not subside, the symptoms increase, the volume of blood is significant, or the streaks do not disappear, this may be a sign of serious problems and illnessesSource: EarwoodJS, ThompsonTD. Hemoptysis: evaluation and management // Am Fam Physician. 2015 Feb 15;91(4):243-9..

White or gray sputum

Transparent sputum, discharge of white and gray shades are absolutely normal. But their excessive quantity may indicate various pathologies, namely:

allergies;
chronic bronchitis;
respiratory tract infections;
pulmonary edema.

Gray sputum may be the result of smoking or severe air pollution.

Diagnostics at the Yusupov Hospital will either refute the suspicion of pathology, and the patient will know for sure that nothing threatens his health, or will allow a timely course of effective treatment to be prescribed and prevent the development of severe complications.

To make an appointment with a doctor at the Yusupov Hospital, you do not need to stand in queues, adjust your work schedule, the hospital administrators will coordinate a visit to the doctor at a time convenient for each patient.

What diseases are typical for hemoptysis?

The appearance of sputum with blood when coughing is called hemoptysis, it is possible with various diseases:

COPD with severe bronchitis or emphysema;
pneumonia (acute or exacerbation of chronic);
tuberculous lesions of the lungs and bronchi;
cancerous tumor in the lungs;
injuries to the chest and lung tissue.

In addition, impurities of blood in coughed up mucus are possible with lesions of the nasopharynx (including nosebleeds) and the upper parts of the digestive tract.

If cough or hemoptysis appears, even without fever, it is important to consult a doctor. This is especially dangerous if symptoms such as fever, shortness of breath, severe weakness, pain in the body or limbs appear against the background of coughing up blood. You need to call an ambulance immediately. Such an attack may be a symptom of a serious illness. It is important to immediately determine the correct diagnosis and begin treatment. Source: K. Krenev, Ya Kabysh, O Yudin. Difficult patient or patient with hemoptysis // Sciences of Europe, 2021, No. 48, pp. 17-22.

2. Reasons

The most common cause of hemoptysis is diseases of the respiratory system. Here it should be remembered that a cough is a repeated spastic contraction of the respiratory muscles with forced exhalation (inhalation may be difficult and incomplete), most often caused by inflammatory, mechanical or chemical irritation of the upper respiratory tract - trachea, bronchi, larynx, as well as nasopharyngeal or pleural receptors.

Accordingly, infectious and inflammatory processes lead among the causes:

tuberculosis;
“smoldering” suppuration in pathologically distended incompetent bronchi (chronic bronchiectasis);
some specific types of bacterial (less often viral) pneumonia;
abscessing inflammatory process in the lungs;
clinically significant bronchitis, acute or chronic.

The second most common group of causes are tumors, both malignant neoplasia in the lungs and benign formations in the bronchi (for example, adenoma).

Other reasons include:

pulmonary thromboembolism (in turn, which can occur under the influence of various factors - thrombophlebitis, surgery, etc.);
some types of severe cardiac pathology (rheumatism, congenital or acquired defects);
trauma and/or foreign body in the lungs;
diseases of the upper gastrointestinal tract;
some genetic, autoimmune, idiopathic diseases (cystic fibrosis, Wegener's granulomatosis, hemorrhagic diathesis, pulmonary hemosiderosis, etc.).

Finally, some sources emphasize that from five to fifteen percent of cases of coughing up blood remain etiologically unclear, i.e. the cause is not identified even with a comprehensive examination.

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Diagnostic methods

Since coughing up blood can be a sign of a serious illness, it is important to make a diagnosis as quickly and accurately as possible. A complex of laboratory tests and necessarily radiography or CT, ultrasound or MRI are required to determine the source of bleeding, especially if it is severe enough. Sometimes blood may not come from the respiratory system, but from soft tissues, the pleural cavity or the esophagus.

A detailed medical history is important - all health problems that preceded the appearance of the cough (smoking, injuries, colds, abdominal pain, etc.). They may indicate possible causes. If the source of bleeding is in the bronchi, an additional bronchoscopy may be prescribed. All diagnostic procedures are usually performed during hospitalization in a clinic.

1.General information

First of all, a few general words should be said about those situations when a person sees his own blood outside the body. If this is a medical procedure (for example, blood sampling for clinical analysis), or a superficial scratch (which, however, must also be aseptically treated to avoid infection), or menstrual blood in women (without any deviations from the established cycle) - worry, Of course it's not worth it.

But any other appearance of blood, even in small or barely noticeable quantities (any signs of hemorrhage, bleeding ulcers, “leaking” effusion, etc.) is in all cases a serious situation, requiring consultation, examination and medical intervention, and often ( depending on a number of circumstances), assistance should be provided not just “in the near future,” but on an urgent or emergency basis.

This is especially true for massive blood impurities in urine, feces or expectorated sputum: such phenomena never arise “just like that” - this is a symptom, and in medicine it is considered one of the most formidable.

Treatment

It is important to remember that hemoptysis is only a symptom. It is important to treat the underlying condition and make efforts to stop the bleeding. If these are inflammatory processes (pneumonia, bronchitis), a course of antibiotics and anti-inflammatory therapy in combination with drugs to regulate blood clotting are indicated. Regular cleansing of the bronchi from bloody sputum (sanitation) is also indicated.

If this is a tuberculosis lesion, anti-tuberculosis therapy is necessary, including surgical interventions on the affected lesions (cavities). For injuries and abscesses, the solution to problems is surgery; for cancerous lesions, tactics are selected individually, depending on the stage. Source: Ittrich H, Bockhorn M, Klose H, Simon M. The Diagnosis and Treatment of Hemoptysis // The Diagnosis and Treatment of Hemoptysis.Dtsch Arztebl Int. 2017 Jun 5;114(21):371-381. doi: 10.3238/arztebl.2017.0371..

4.Treatment

Therapy in any case will be etiopathogenetic in nature (as far as possible), i.e. The main target will not be the cough itself, but the factors that cause it. The range of therapeutic approaches in modern pulmonology (and medicine in general) is extremely wide; their specific choice is determined by the diagnostic results. In some cases, standard anti-inflammatory treatment is sufficient, in others there are absolute indications for emergency surgery, etc.

It is important to emphasize once again: a doctor’s consultation is needed urgently or urgently if:

“bloody” sputum expectorated with a cough is very copious and/or has a strong unpleasant odor;
cough mixed with blood occurs against the background of “unreasonable” recent loss of body weight, hyperhidrosis (excessive sweating), fatigue;
cough is accompanied by signs of pulmonary hemorrhage (profuse, frothy scarlet blood).

Prevention

The main methods of preventing hemoptysis are preventing the pathologies that cause it. Quitting smoking, maintaining a healthy lifestyle, regular exercise, and timely treatment of colds are important.

Sources:

Earwood JS, Thompson TD. Hemoptysis: evaluation and management // Am Fam Physician. 2015 Feb 15;91(4):243-9.
Ittrich H, Bockhorn M, Klose H, Simon M. The Diagnosis and Treatment of Hemoptysis // The Diagnosis and Treatment of Hemoptysis.Dtsch Arztebl Int. 2021 Jun 5;114(21):371-381. doi: 10.3238/arztebl.2017.0371.
K. Krenev, I am Kabysh, O Yudin. Difficult patient or patient with hemoptysis // Sciences of Europe, 2021, No. 48, pp. 17-22

Sputum due to pneumonia is yellow in color

The appearance of a yellow tint in the sputum may indicate the development of acute pneumonia and acute bronchitis. It can also be a sign of allergies and asthma.

Yellow sputum indicates the body is fighting the virus and the immune system is functioning normally. Thick, dark yellow mucus may be due to a bacterial infection in sinusitis. If such a symptom appears, you should immediately seek medical help.

Trust your health to professionals. Doctors at the Yusupov Hospital are leading specialists in Russia who, based on the test results, will make an accurate diagnosis and develop an effective treatment plan for each patient.

Pneumonia is often a consequence of improperly prescribed treatment. In public clinics, quite often patients are treated for pathologies that they have never had, while the underlying disease develops at a faster rate. This picture is observed due to the low qualifications of doctors in state clinics, poor equipment of hospitals with modern medical equipment and the lack of medicines.

Possible complications

Ignoring the symptoms of minor hemoptysis can lead to the development of massive bleeding.
It causes the airways to fill with blood, which blocks access to air. As a result, death from asphyxia (suffocation) may occur. Death is also possible with heavy blood loss, amounting to about 4–4.5% of the total body weight. If left untreated, the disease that caused hemoptysis continues to progress and cause complications. With cancer, metastases appear, with pneumonia and tuberculosis - fibrosis of the lung tissue, with bronchiectasis - bleeding, abscess, infarction and necrosis of the lung.

Causes of bloody sputum

Blood in the sputum may appear due to genetic abnormalities; the symptom indicates diseases of the respiratory system, heart and blood vessels; sometimes the causes are harmless. Hemoptysis (hemoptysis) develops against the background of an inflammatory process, fungal infection, or infection with parasites.

Blood when coughing - safe reasons

Bloody streaks in mucus are not always a sign of serious pathological processes.

Sometimes unpleasant symptoms are short-lived, disappear on their own within 1–3 days, occur without an increase in temperature, the person’s general well-being does not deteriorate, the sputum has a brown tint with streaks of reddish-rusty blood.

Why does blood appear from the throat:

rupture of small capillaries in the bronchi during a hysterical cough;
heavy physical effort;
long-term use of anticoagulants.

Profuse hemoptysis is the most dangerous for humans - the daily volume of blood clots exceeds 500 ml.

Respiratory diseases

Hemoptysis often occurs with influenza, ARVI, and respiratory tract pathologies. The mucus contains red streaks, and sometimes pulmonary bleeding occurs.

Mucus with blood clots - what could it be:

In case of bronchitis, bronchiectasis, pus and blood are released during coughing; the disease causes shortness of breath, decreased ability to work, and increased temperature.
In case of pneumonia, when coughing up, mucus of a rusty color with scarlet clots appears. The disease is accompanied by high fever, signs of severe intoxication, shortness of breath appears even with minor physical effort.
Lung abscess – profuse sweating, prolonged fever, pain during breathing, loss of appetite. The discharge is purulent with bloody patches and has a foul odor.
With tuberculosis, the main symptoms are an increase in temperature to subfebrile levels, sudden weight loss, lack of appetite, purulent and bloody clots are observed in the sputum.
Adenoma in the bronchi - when coughing, a little bloody sputum is released from the mouth, breathing becomes like hiccups, the person becomes weaker and loses weight.
In case of lung cancer, the presence of metastases, sputum streaked with blood appears, coughing attacks are prolonged, accompanied by suffocation. The person begins to quickly lose weight and sweats intensely at night.
With tracheitis, tonsillitis, laryngitis, the throat becomes very sore and sore, the voice becomes hoarse, the cough is dry with scanty pink discharge.
Pneumothorax is a dangerous complication of lung injury, accompanied by shortness of breath, decreased blood counts, the patient becomes restless, complains of chest pain and lack of air. Without timely professional help, the condition can lead to death.

With sore throat, which is caused by streptococci, blood appears when coughing up due to improper mechanical cleansing of the tonsils from pus, which leads to tissue injury. If the causative agent of the disease is staphylococci, then against the background of a strong response of the immune system, vasodilation occurs in the area of inflammation, but the surface of the mucous membrane forms a red blood cell mass, which is discharged with mucus.

Hemoptysis is a symptom of a fungal infection in the lungs; it appears when helminths and protozoa penetrate the lung tissue.

The most common cause of blood when a child coughs is the ingestion of foreign objects. You need to call an ambulance immediately - the situation is life-threatening.

Cardiovascular pathologies are the main causes of blood discharge from the larynx

Important! Bloody sputum without cough is one of the signs of disturbances in the functioning of the heart and blood vessels; they are dangerous and require immediate specialized care.

List of main pathologies

Disease	Characteristic signs
Pulmonary infarction, blockage of the pulmonary artery	Rare hemoptysis, sometimes constant bleeding for several days. Tachycardia, pain, severe shortness of breath, fever, cyanosis
Cardiac pulmonary edema	Severe and constant shortness of breath, copious sputum interspersed with blood of a foamy consistency
Mitral stenosis	Cough and hemoptysis appear with physical effort
Rupture or rupture of an aortic aneurysm	Frequent pulmonary hemorrhages, which can cause death

Sometimes blood is present in saliva, which is associated with bleeding gums, dehydration, hypothyroidism, tuberculosis, and carcinoma. Mucus with bloody streaks may appear due to snot with blood - such symptoms often occur with a cold, increased intracranial pressure, and mechanical damage.

Sometimes hemoptysis occurs with endometriosis in women - the endometrium grows into the lung tissue, unpleasant symptoms appear during menstrual bleeding.

Hemoptysis due to congenital pathologies

Some congenital diseases of the bronchopulmonary system provoke the appearance of mucus with bloody spots.

Main pathologies:

cystic fibrosis - the appearance of mucus with blood clots is caused by bronchiectasis;
rupture of a bronchial cyst - purulent mucus with blood clots, pain when inhaling, possible development of pneumothorax;
hypoplasia of the pulmonary vessels - shortness of breath, suffocation, cough and hemoptysis occur rarely;
hemorrhagic telangiectasia - there are many hemorrhages on the body and mucous membranes.

If the blood is bright, foamy, and a slight sore throat appears before coughing, this means that the pathology is caused by a dysfunction of the respiratory system. If nausea appears before the attack, the blood in the sputum is thick, it is necessary to diagnose the digestive organs.

Treatment methods in Medscan

The choice of treatment methods depends on the disease that caused hemoptysis and the stage of its development. For malignant neoplasms in the lungs, the following are prescribed:

early resection;
chemotherapy;
radiation therapy;
immunotherapy;
targeted therapy;
stereotactic radiotherapy.

In case of massive bleeding, Medscan specialists perform embolization of the bronchial artery. This is a minimally invasive method that involves blocking a bleeding vessel. It allows you to stop blood loss in 90% of cases. If there is no effect, emergency surgery is performed.

Treatment of sputum with blood

Treatment of cough with sputum is carried out in a hospital, where the dynamics of the development of pathology are constantly monitored, the effectiveness of therapy is analyzed, and the volume of discharge is measured. Lung cancer, abscess, and a number of other severe pathologies will require surgical intervention.

Main groups of medicines:

antitumor drugs - Cisplatin, Vinorelbine, prescribed for lung cancer;
first-line tuberculostatic drugs for tuberculosis - Ethambutol, Isoniazid;
antibiotics – Amoxiclav, Tavanik;
antiviral drugs – Anaferon, Arbidol;
mucolytics – Mucaltin, ACC, Gedelix;
antiviral drugs - Erespal, Sinekod, Bronchipret;
antitussive drugs with an anesthetic effect - Codeine, Glaucine.

After the patient’s condition improves, the patient is transferred to outpatient treatment, vitamin complexes and immunomodulators are prescribed to restore the immune system.

Causes of sputum

Mucus in the throat

- a natural reaction of our body to the appearance of an irritant. In this way, the body protects itself from infection: sputum increases in volume, and a person involuntarily coughs to free himself from viruses and harmful bacteria. After recovery, the amount of mucus returns to its normal, imperceptible level. If the feeling of phlegm in the throat has become constant, this may indicate a chronic ENT disease, or problems in the digestive and other systems of the body.

The causes of excess mucus can be different:

cold;
bronchitis;
bronchial asthma;
pneumonia (pneumonia);
tuberculosis;
sinusitis;
chronic rhinitis;
lung cancer.

In addition to the listed pathologies, smoking can also be a cause of sputum separation. In smokers, the mucous membrane of the respiratory tract is constantly exposed to the toxic effects of nicotine and cigarette tar. Chronic inflammation gradually provokes the production of sputum in quantities that force a person to cough every morning.

Diagnostics

A qualified pulmonologist should identify the etiological factors that lead to the release of green sputum. During the examination, attention is paid to the symmetry of the participation of the chest in the act of breathing, signs of pulmonary insufficiency, and characteristic respiratory sounds are listened to. Informative diagnosis of diseases is impossible without laboratory and instrumental methods:

X-ray examination.
X-ray of the chest in frontal and lateral projection shows areas of inflammatory infiltration of the lung tissue, areas of compaction, and contours of neoplasms. CT scan of the lungs helps to visualize the structure of the organ in detail. Bronchography is used to identify signs of bronchial deformation.
FVD study.
For the diagnosis of chronic bronchopulmonary diseases, spirometry is indicated, the results of which determine the vital capacity of the lungs, the volume of forced expiration and the degree of reversibility of changes. To quickly assess respiratory function, the peak flowmetry method is used.
Bronchoscopy.
Visualization of the bronchial tree by the endoscopic method is necessary when there are difficulties in differential diagnosis or when a malignant process is suspected. The method shows the condition of the bronchial mucosa, allows you to detect deformations and neoplasia. If necessary, a biopsy is taken using a bronchoscope.
Sputum analysis.
Microscopic examination of the biomaterial evaluates the content of blood cells, the presence of bacteria or fungal spores. Staining for acid-fast bacteria is required to exclude tuberculosis. Next, a bacteriological analysis of the discharge is performed.

Additionally, a clinical and biochemical blood test is required, which reveals signs of an inflammatory process. To clarify the diagnosis, an MRI of the lungs is performed. To examine the surface of the lung tissue, diagnostic thoracoscopy is recommended. If green sputum is caused by an infection of the nasal cavity, an otolaryngologist is consulted with rhinoscopy and x-ray of the paranasal sinuses.

Inhalation therapy

Does blood when coughing always indicate pathology?

Having noticed bloody discharge when coughing, you cannot ignore this fact. In this matter, extra caution will not harm, despite the fact that, indeed, there are some harmless reasons that can provoke the appearance of a scarlet tint. Among them are:

damage to capillaries due to severe coughing;
intense physical activity;
stress;
taking medications that reduce blood viscosity.

In this case, minor streaks of blood or a brownish tint may be detected in the secretion when coughing. This symptom goes away on its own within 1–2 days.

Other rare causes and pathologies

Sometimes it is very difficult to determine the nature of hemoptysis. This is especially true in situations where the problem is caused by conditions that are extremely rare. These include:

sarcoidosis – damage to the lymphatic system of the respiratory organs, which causes the patient sweating, shortness of breath, dry painful cough, weight loss and other symptoms;
thrombocytopenia, leukemia and other blood diseases - cause an increase in the volume of the liver, spleen, decreased immunity, and subcutaneous hemorrhages. Sputum when coughing often has a scarlet tint, which is caused by the penetration of blood into the vessels of the lungs due to their increased permeability;
polyarteritis nodosa - accompanied by hemorrhages in the lung area. Patients with this pathology suffer from chronic bronchitis, pneumonia, severe cough mixed with blood;
endometriosis in women - scarlet sputum can be caused by the germination of the endometrium into the lung tissue;
systemic lupus erythematosus is a severe autoimmune disease that causes hemorrhages in the lungs, weakness, fever and other manifestations in patients;
Wegener's granulomatosis - provokes hemoptysis, wheezing, scarring of the tissues of the respiratory organs, weight loss, the formation of ulcers in the nose and nasopharynx, hoarseness, difficulty breathing and other clinical signs.

The prognosis for a patient with the development of rare pathologies depends on the correctness of therapy, the characteristics of the course of the disease and timely diagnosis.

Reasons for changing the color of discharge

There can be quite a few sources of brown sputum. Generally speaking, this shade of mucus occurs due to old infectious processes. It is believed that the breakdown of red blood cells in the bronchial structures enters a chronic phase.

Smoking. This dangerous habit can cause various complications. One of the symptoms of long-term poisoning of the respiratory tract with poisons, tars and soot is brown sputum. This color of phlegm occurs due to abnormal capillary permeability. Intoxication provokes blood to leak out of the vessels.

Smoking phlegm looks like a thick clot of mucus. That is why the symptom of the disease usually appears in the morning, after a long stay in a horizontal position.

Bronchitis is considered one of the most common diseases characterized by the release of brown sputum during coughing. The cause of the inflammatory process and expectoration of brown phlegm is hypothermia, untimely or inadequate treatment of an infectious lesion of the upper respiratory tract.

Diagnosing bronchitis based on the first symptoms is very difficult. The signs of the disease are in many ways similar to the manifestations of common ARVI, acute respiratory infections. The only difference is the duration of the cough. Brown sputum is also not indicative. This shade of mucus is given by blood from burst vessels.

Tuberculosis. Everyone needs to know the symptoms of such a disease. Unfortunately, you can pick up Koch sticks in any public place. The main condition for the development of the disease is weakened immunity. At the initial stages, the mucus is transparent, without impurities or streaks. The appearance of brown sputum is considered a bad sign. If dark phlegm goes away in the morning, the patient needs emergency medical care.

Pneumonia. The disease is often confused with bronchitis. The diseases have similar symptoms and causes. Brown sputum in this case is not indicative. It may indicate both rupture of blood vessels and the appearance of blood from lung tissue in the mucus. Hardware diagnostics are important.

Oncology. The most terrible diagnosis that a patient in a medical institution can hear is lung cancer. This disease causes the degeneration of healthy tissues into atypical forms. The process is always accompanied by hemoptysis caused by the growth of metastases into the lungs and upper respiratory tract.

Help from traditional medicine

In case of occasional vascular ruptures and decreased tone of arterial walls, the use of the following non-traditional means is allowed:

Juice from yarrow herb. The liquid is consumed 10 ml every 30 minutes until the patient’s condition stabilizes;
Chicory infusion. One tablespoon of herb should be poured into a liter of boiling water and left for 30 minutes. Drink 100 ml every 30 minutes;
Infusion of geranium leaves. To create the medicine, 30 g of raw materials are used. The amount of boiling water and the principle of use are the same as the recipe described above.

Folk remedies are powerless for heavy bleeding in the respiratory tract.