Coughing up blood
Hemoptysis; Spitting up blood; Bloody sputum
Coughing up blood is the spitting up of blood or bloody mucus from the lungs and throat (respiratory tract).
Hemoptysis is the medical term for coughing up blood from the respiratory tract.
The major passages and structures of the upper respiratory tract include the nose or nostrils, nasal cavity, mouth, throat (pharynx), and voice box (larynx). The respiratory system is lined with a mucous membrane that secretes mucus. The mucus traps smaller particles like pollen or smoke. Hairlike structures called cilia line the mucous membrane and move the particles trapped in the mucus out of the nose. Inhaled air is moistened, warmed, and cleansed by the tissue that lines the nasal cavity.
The major passages and structures of the lower respiratory tract include the windpipe (trachea) and within the lungs, the bronchi, bronchioles, and alveoli. Deep in the lungs, each bronchus divides into secondary and tertiary bronchi, which continue to branch to smaller airways called the bronchioles. The bronchioles end in air sacs called the alveoli. Alveoli are bunched together into clusters to form alveolar sacs. Gas exchange occurs on the surface of each alveolus by a network of capillaries carrying blood that has come through veins from other parts of the body.
Considerations
Coughing up blood is not the same as bleeding from the mouth, throat, or gastrointestinal tract.
Blood that comes up with a cough often looks bubbly because it is mixed with air and mucus. It is most often bright red, although it may be rust-colored. Sometimes the mucus contains only streaks of blood.
The outlook depends on what is causing the problem. Most people do well with treatment to treat the symptoms and the underlying disease. People with severe hemoptysis may die.
Causes
A number of conditions, diseases, and medical tests may make you cough up blood. These include:
- Blood clot in the lung
- Breathing food or other material into the lungs (pulmonary aspiration)
- Bronchoscopy with biopsy
- Bronchiectasis
- Bronchitis
- Lung cancer
- Cystic fibrosis
- Inflammation of the blood vessels in the lung (vasculitis)
- Injury to the arteries of the lungs
- Irritation of the throat from violent coughing (small amounts of blood)
- Pneumonia or other lung infections
- Pulmonary edema
- Systemic lupus erythematosus
- Tuberculosis
- Very thin blood (from blood thinning medicines, most often at higher than recommended levels)
Home Care
Medicines that stop coughing (cough suppressants) may help if the problem comes from heavy coughing. These medicines may lead to airway blockages, so check with your health care provider before using them.
Keep track of how long you cough up blood, and how much blood is mixed with the mucus. Call your provider any time you cough up blood, even if you do not have any other symptoms.
When to Contact a Medical Professional
Get medical help right away if you cough up blood and have:
- A cough that produces more than a few teaspoons of blood
- Blood in your urine or stools
- Chest pain
- Dizziness
- Fever
- Lightheadedness
- Severe shortness of breath
What to Expect at Your Office Visit
In an emergency, your provider will give you treatments to control your condition. The provider will then ask you questions about your cough, such as:
- How much blood are you coughing up? Are you coughing up large amounts of blood at a time?
- Do you have blood-streaked mucus (phlegm)?
- How many times have you coughed up blood and how often does it happen?
- How long has the problem been going on? Is it worse at some time such as at night?
- What other symptoms do you have?
The provider will do a complete physical exam and check your chest and lungs. Tests that may be done include:
- Bronchoscopy, a test to view the airways
- Chest CT scan
- Chest x-ray
- Complete blood count
- Lung biopsy
- Lung scan
- Pulmonary arteriography
- Sputum culture and smear
- Test to see if the blood clots normally, such as PT or PTT
References
Brown CA. Hemoptysis. In: Walls RM, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 10th ed. Philadelphia, PA: Elsevier; 2023:chap 20.
Swartz MH. The chest. In: Swartz MH, ed. Textbook of Physical Diagnosis: History and Examination. 8th ed. Philadelphia, PA: Elsevier; 2021:chap 13.
Version Info
Last reviewed on: 5/3/2023
Reviewed by: Michael M. Phillips, MD, Emeritus Professor of Medicine, The George Washington University School of Medicine, Washington, DC. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
