hemoptysis

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More about Hemoptysis: Causes and symptoms Diagnosis Treatment Prognosis Resources

Definition

Hemoptysis is the coughing up of blood or bloody sputum from the lungs or airway. It may be either self-limiting or recurrent. Massive hemoptysis is defined as 200–600 mL of blood coughed up within a period of 24 hours or less.

Description

Hemoptysis can range from small quantities of bloody sputum to life-threatening amounts of blood. The patient may or may not have chest pain.

— Rebecca J. Frey

Dictionary: he·mop·ty·sis   (hĭ-mŏp'tĭ-sĭs)

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The expectoration of blood or of blood-streaked sputum from the larynx, trachea, bronchi, or lungs.

[HEMO– + Greek ptusis, a spitting (from ptuein, to spit).]

Key Terms: Bronchial adenoma, Bronchial carcinoma, Hemangioma.

Description

Hemoptysis is the coughing up of blood or bloody sputum from the respiratory tract. The blood can come from the nose, mouth, throat, airway passages leading from the lungs, or the lungs.

Hemoptysis can range from small quantities of blood-stained sputum to life-threatening amounts of blood. Massive hemoptysis is defined as the spitting up of so much blood that it interferes with the patient's breathing. Generally, this is 200 to 600 or more milliliters of blood coughed up within a 24 hour period. Massive hemoptysis is considered a medical emergency. Up to 75 percent of patients with massive hemoptysis die from asphyxiation (lack of oxygen) caused by too much blood in the airways.

Hemoptysis refers specifically to the spitting up of blood that comes from the respiratory tract. Often when persons spit up blood, they are not spitting up blood from the respiratory tract, but from somewhere else. When the blood comes from somewhere other than the respiratory tract, such as from a bloody nose or from the gastrointestinal tract, this is called pseudohemoptysis. Vomiting up blood from the gastrointestinal tract, called hematemesis, is one type of pseudohemoptysis. It is important to distinguish between true hemoptysis and pseudohemoptysis because they often involve very different parts of the body and the treatments are radically different.

Causes

Hemoptysis is caused by a variety of medical conditions including tuberculosis, bronchitis, bronchiectasis, pneumonia, and respiratory tract trauma. It is also caused by many forms of lung and respiratory tract cancers, such as: bronchial carcinoma, bronchial adenoma, respiratory tract hemangioma, and occasionally by metastatic cancer to the lungs.

Treatments

The goal of treatment for patients with hemoptysis is to stop the bleeding as soon as possible while also treating the cancer or other underlying disorder that is causing the hemoptysis.

Hemoptysis generally will stop spontaneously and no treatment is necessary, apart from reassurance of the patient that this condition will resolve on its own. Therefore, the general treatment for hemoptysis is to keep the patient calm and to ensure complete bed rest.

If the coughing that accompanies the hemoptysis is troublesome or aggravating the condition, cough suppressants may be recommended.

In cases of massive hemoptysis, the placement of a tube in the respiratory tract (intubation) may be necessary to allow for adequate airflow into and out of the respiratory tract. A bronchoscopy may be performed, not only to clear the airway of blood, but also to assist in diagnosing the endobronchial cause of the hemoptysis. When large amounts of blood have been lost, the patient may also require intravenous (IV) fluids and/or a blood transfusion.

In the most severe cases of hemoptysis, surgery to remove the cancer that is causing the spitting up of blood may be necessary to relieve the symptoms of hemoptysis. Other treatment modalities include PDT (photodynamic therapy).

Alternative and Complementary Therapies

Inhalation of the fumes of a tea made from the bark of the wild cherry (Prunus virginiana) tree has been an herbal remedy for many respiratory tract ailments, including tuberculosis and hemoptysis among the Native Americans for centuries.

Hydrazine sulfate, a naturally occurring monoamine oxidase inhibitor (MAOI), has also been suggested as a treatment for hemoptysis.

Resources

Organizations

The Alliance for Lung Cancer (ALCASE). 1601 Lincoln Avenue, P. O. Box 849, Vancouver, WA 98666. Telephone 1-800-298-2436. Fax 360-735-1305. .

American Lung Association (ALA). 1740 Broadway, New York, NY 10019. Telephone 1-212-315-8700. .

—Paul A. Johnson, Ed.M.

The expectoration of blood, by coughing, from the larynx or lower respiratory tract.

Coughing and spitting of blood as a result of bleeding from any part of the respiratory tract. In true hemoptysis the sputum is bright red and frothy with air bubbles; it must not be confused with the dark red or black color of hematemesis.
Hemoptysis is a most unusual sign in animals, most aspirated blood being swallowed. Anything more profuse than that may gush from the nostrils and the mouth but that can hardly be classified as spitting.

• endemic h. — schistosomiasis.

Hemoptysis

ICD-10	R04.2
ICD-9	786.3
DiseasesDB	5578
MedlinePlus	003073
MeSH	D006469

Hemoptysis or haemoptysis is the expectoration (coughing up) of blood or of blood-stained sputum from the bronchi, larynx, trachea, or lungs (e.g. in tuberculosis or other respiratory infections).

Causes

This can be due to bronchitis or pneumonia most commonly, but also to lung neoplasm (in smokers, when hemoptysis is persistent), aspergilloma, tuberculosis, bronchiectasis, coccidioidomycosis, pulmonary embolism, or pneumonic plague.

Rarer causes include hereditary hemorrhagic telangiectasia (HHT or Rendu-Osler-Weber syndrome), or Goodpasture's syndrome and Wegener's granulomatosis.

In children it is commonly due to a foreign body in the respiratory tract.

It can result from over-anticoagulation from treatment by drugs such as warfarin.

Cardiac causes like congestive heart failure and mitral stenosis should be ruled out.

The origin of blood can be known by observing its color. Bright red, foamy blood comes from the respiratory tract while dark red, coffee-colored blood comes from the gastrointestinal tract.

Extensive injury can cause one to cough up blood.

Diagnostic workup

External links

• Haemoptysis at GPnotebook
• Haemoptysis Virtual Cancer Centre

v • d • e Symptoms and signs: circulatory and respiratory systems (R00-R09 · 785-786) Cardiovascular system Heart Tachycardia/Bradycardia · Palpitation Heart sounds: Heart murmur (Systolic, Diastolic, Continuous) · Gallop rhythm (Third heart sound, Fourth heart sound) · Pericardial friction rub · Split S2 · Heart click Pulse abnormalities Pulsus alternans · Pulsus bigeminus · Pulsus bisferiens · Pulsus tardus et parvus · Pulsus paradoxus Other peripheral blood flow Bruit/Carotid bruit · Gangrene · Cannon A waves Respiratory system Hemorrhage Epistaxis · Hemoptysis Abnormalities of breathing Respiratory sounds: Stridor · Wheeze · Rales · Rhonchi · Hamman's sign Dyspnea · Hyperventilation/Hypoventilation · Hyperpnea/Tachypnea/Bradypnea · Orthopnea/Platypnea Biot's respiration · Cheyne-Stokes respiration · Kussmaul breathing Hiccup · Mouth breathing/Snoring Other Asphyxia · Cough · Pleurisy · Sputum Respiratory arrest · Hypercapnia/Hypocapnia Whispered pectoriloquy · Egophony · Bronchophony Chest, general Chest pain see also eponymous medical signs for circulatory and respiratory systems

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