If you ever see blood coming with cough, you must see a doctor. If the blood is very little, it may not be worrisome but if you frequently encounter such a situation, it should be given proper medical attention. In medical terms, this condition is called Hemoptysis. Onlymyhealth contacted Dr. Sandeep Nayar, Senior Director and HOD, BLK Centre for Chest and Respiratory Diseases, Delhi to understand more about hemoptysis. Read all the details in this article.
What is Hemoptysis?
Hemoptysis is referred to as the condition where expectoration of blood from the lower respiratory tract happens. This condition is classified into the following based on the expectorated blood:
- Scanty (when the patient complains of blood-tinged sputum or streaks of blood while coughing. The amount is less than 20 ml i.e. tablespoon
- Frank hemoptysis (frank blood mixed with sputum though the amount may be less than 100-200 ml (about a cup) of blood in 24 hours.
- Massive hemoptysis generally describes expectoration of at least 200 mL of blood (some consider at least 500ml) in 24 hours. Broadly speaking any amount of bleeding that is potentially acutely life-threatening is considered Massive or Life-threatening Hemoptysis.
Common causes of blood while coughing
Here are some possible causes of hemoptysis:
- Bronchitis, either short-term (acute) or long-term (chronic)
- Chronic obstructive pulmonary disease (COPD)
- Different types of Pneumonia
- Benign Lung Tumor
- Lung Abscess
- Lung cancer
- Trauma to the chest causing lung contusion
- Congestive heart failure, especially because of mitral stenosis
- Foreign objects in airways
- Use of blood thinners (anticoagulants)
- Pulmonary arteriovenous malformations (AVMs)
- Pulmonary embolism
- Parasitic infection
- Inflammatory/autoimmune conditions (Goodpasture disease etc.)
One must visit a doctor/hospital to undergo thorough investigation which starts from detailed physical examination and History taking.
How is Hemoptysis diagnosed?
To investigate the condition, doctors conduct the following tests:
- Complete blood count (CBC)
- Chest X-ray
- CT Scan
- Blood chemistry profile including Kidney functions
- Coagulation tests
- Pulse Oximetry
- Arterial Blood Gas analysis
- Bronchoscopy (Endoscopy of the lung to look for the site of bleeding and may even try to stop it by various methods)
Upon proper investigation, your doctor would recommend you the right treatment.
How is hemoptysis treated?
Treatment depends primarily on two factors: the amount of blood being coughed out and the factors causing it. Dr. Sandeep Nayar explains:
The first step is to stabilise the patient as it can be life-threatening at times. Mild hemoptysis can be managed on Out Patient (OPD) basis. A course of antibiotics as well as a hemostatic agent may suffice in most of the mild hemoptysis due to an infection.
In case of massive hemoptysis, the patient should be immediately admitted. Intravenous fluids to be administered as there may be loss of blood casing hypovolemia. Oxygen should be administered as they tend to be hypoxic. After stabilising a patient, a cause should be ascertained and the rest of the treatment is given accordingly which includes:
- Cryotherapy: Bronchial artery Embolization may be done if hemoptysis persists
- Surgery: In some cases, we may have to remove a portion or even the entire one lung if the hemoptysis fails to stop otherwise.
- Cold saline instillation
- Medications causing vasoconstrictors like epinephrine
- Coagulants to help blood clot like tranexamic acid
- Bronchoscopy may be done to localise the site of bleeding and try to stop it by
- Glue Therapy (instilling cyanoacrylate glue over the bleeding site)
- balloon tamponade/Bronchial Blockers(Tiny balloons or cuffs to put pressure on the area bronchial
- Cauterisation of the lesion
- Laser therapy
- Argon plasma coagulation (APC)
Timely diagnosis and treatment can secure the health of a person. Soon after you spot blood in your cough, you must consult the doctor. Hemoptysis is preventable and manageable.
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