Coughing Up Blood (Hemoptysis): Warning Signs, Causes and When to Act

What it involves

The MedlinePlus encyclopedia explains that coughing up blood is the spitting up of blood or bloody mucus from the lungs and throat, and that hemoptysis is the medical term for coughing up blood from the respiratory tract. It is not the same as bleeding from the mouth, throat or digestive tract.

Who this is for

• Adults who have coughed up blood-streaked mucus once or more than once.
• Patients with a long-lasting cough, a lung infection or a past lung condition who notice blood.
• People who take blood-thinning medicines and see blood when they cough.
• Anyone who needs a follow-up visit after being seen in an urgent care or ER for coughing up blood.

What to expect

• Questions about how much blood, how often, how long it has gone on and what other symptoms you have
• A check of your chest and lungs and a review of the medicines you take, including blood thinners
• Blood work, which the practice offers, such as a complete blood count
• A referral for a chest x-ray, CT scan or a lung specialist when the cause needs imaging or a closer look

Call 911 or go to the ER first

Do not wait for an appointment if you cough up more than a few teaspoons of blood, or if any amount comes with chest pain, severe shortness of breath, dizziness, lightheadedness, fever, or blood in your urine or stools. These are the signs the MedlinePlus encyclopedia lists for getting medical help right away. Heavy bleeding from the lungs can block breathing, so call for an ambulance rather than driving yourself. The chest pain guide and the sick visit, urgent care or ER guide help you choose where to go.

What it looks like

According to the encyclopedia, 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, and sometimes the mucus contains only streaks of blood. That helps tell it apart from blood that comes from the stomach, which is covered in the blood in stool guide for the other end of the digestive tract. Keep track of how long it lasts and how much blood is mixed in, because your provider will ask.

Causes MedlinePlus lists

The encyclopedia names a blood clot in the lung, breathing food or other material into the lungs, bronchiectasis, bronchitis, lung cancer, cystic fibrosis, inflammation of blood vessels in the lung, injury to the lung arteries, pneumonia and other lung infections, pulmonary edema, lupus and tuberculosis. Very thin blood from blood-thinning medicines, and irritation of the throat from violent coughing, can cause small amounts. The pulmonary embolism guide, the pneumonia guide and the tuberculosis guide describe three of these.

What a visit covers

Once you are stable, your provider asks how much blood you are coughing up, how often, how long it has gone on, whether it is worse at night, what other symptoms you have and whether you take blood thinners. A physical exam includes your chest and lungs. The encyclopedia lists tests that may be done, including a complete blood count, a clotting test, chest x-ray, CT scan, sputum culture, bronchoscopy and lung biopsy. The practice offers blood work, and the complete blood count guide explains one common test. Imaging and bronchoscopy are arranged by referral.

What to do while you wait for the visit

MedlinePlus says to contact your provider any time you cough up blood, even without other symptoms, and to keep track of how long it happens and how much blood is in the mucus. It also warns that medicines that stop coughing may help when heavy coughing is the cause but can lead to airway blockages, so check with your provider before using them. Do not take new blood thinners or aspirin on your own. If you smoke, the quitting smoking guide explains how a provider can help you stop.

How a primary care provider fits in

Primary care is the place to sort out a minor, one-time streak after a hard cough, to review your medicines, and to arrange chest imaging or a lung specialist when needed. It is not the place for heavy bleeding, which needs an ER. A cough that lasts for weeks, with or without blood, is covered in the persistent cough guide, and weight loss with it is covered in the unintentional weight loss guide. Bring a note of the dates and amounts you saw.

Sources

• MedlinePlus Medical Encyclopedia: Coughing up blood