Hemoptysis – diagnosis and treatment

Hemoptysis is nothing but coughing blood from the lungs. It can be due to threatening medical infections like cancer and other severe deteriorating medical conditions. You need to immediately consult a doctor if you spot blood while you cough.

Hemoptysis types are divided based on how much blood you cough over a period of 24 hours. It is very hard to foretell the exact type of Hemoptysis without proper examination. However, the following Hemoptysis are classified based on the blood that comes out from the respiratory tract. This includes:

Massive Hemoptysis

Massive Hemoptysis is a life-threatening Hemoptysis. Massive Hemoptysis ranges from 100 millilitres (mL) of blood to over 600 millilitres (mL) of blood.

Non-massive Hemoptysis

This Hemoptysis is also known as Nonlife-threatening Hemoptysis. In this Hemoptysis, a person coughs up between 20 and 200 mL of blood.

Mild Hemoptysis

Mild Hemoptysis is also known as scant Hemoptysis. In this Hemoptysis, a person coughs less than 20 mL of blood.

Symptoms of Hemoptysis 

Consult your doctor if you come across any of these symptoms:

• Chest pain
• Weight loss
• Soaking sweat at night
• High fever
• Shortness of breath

Causes of Hemoptysis

Multiple things can make you cough up blood. Common causes include:

• Bronchitis
• Lung cancer
• Damaged airways Pneumonia
• Tuberculosis
• Chronic obstructive pulmonary disease (COPD)

Other causes

• Congestive heart failure
• Crack cocaine usage
• Inflammatory or autoimmune conditions like Behcet disease
• Lung abscess
• Non-cancerous lung tumours
• Parasitic infection
• Pulmonary arteriovenous malformations (AVMs)
• Pulmonary embolism
• Use of blood thinners  
• Endometriosis
• Hughes-Stovin syndrome
• Hereditary hemorrhagic telangiectasia
• Sarcoidosis

In some cases, doctors can be very puzzled about determining the cause of Hemoptysis.

 Hemoptysis diagnosis  

If you’re coughing up blood, here’s how you can figure out ways to identify Hemoptysis.

• Medical history. This gives your doctor a clue about your previous medical conditions.
• Chest X-ray. This test determines your chest mass or areas of fluid or congestion in your lungs.
• CT scan. This scan captures images of your inner chest.
• Bronchoscopy. This test is all about inserting a flexible tube with a camera on both ends through your nose or mouth. This technique is called a bronchoscope.
• Complete blood count (CBC). This test determines exactly the number of white and red blood cells in your blood, along with platelets (cells that help blood clot).
• Urinalysis. In rare cases. Hemoptysis can also be analysed by simple urine tests.
• Blood chemistry profile. This test measures the health of your kidneys and also determines the electrolyte content of your body.
• Arterial blood gas. This test brings out the details of levels of oxygen and carbon dioxide in your blood.

Types of Hemoptysis 

Endemic Hemoptysis 

Endemic Hemoptysis can be present in infection with Paragonimus westermani. Paragonimus is an infection that causes Endemic Hemoptysis. Endemic Hemoptysis is also known to be an Oriental lung fluke infection. This type of Hemoptysis is caused by consuming raw, pickled or poorly cooked freshwater crustaceans.

Frank Hemoptysis 

Frank Hemoptysis is caused due to expectoration of blood coming out from the respiratory tract. Frank Hemoptysis is majorly characterised by sputa that are grossly bloody but have a volume less than 100-200mL in 24 hours. The most common cause of Frank Hemoptysis is Bronchitis and Pneumonia.

Spurious Hemoptysis 

Spurious Hemoptysis is present secondary to the upper respiratory tract just above the level of the Larynx. Spurious Hemoptysis exists above the vocal cord. It does not persist and can be easily spotted through ENT examination.

Psuedo Hemoptysis

Psuedo Hemoptysis is a type of Hemoptysis closely associated with the Serratia marcescens infection. Pseudo Hemoptysis has the appearance of red-coloured sputum without the presence of Red Blood Cells. Pseudo Hemoptysis is mostly caused due to COPD, Asthma and Bronchitis.

Hemoptysis Treatments 

The following are some of the effective treatments for Hemoptysis. Treatment truly depends on how much blood you’re coughing outside.

Treatment for massive Hemoptysis

A tube is inserted into your airways to determine the bleeding region.

Your doctor can stop the bleeding in the following ways:

• Iced saline
• Apply medications to narrow blood vessels  
• Tiny balloons
• Laser therapy
• Argon Plasma Coagulation (APC)
• Cryotherapy
• Embolisation

In rare cases, a doctor may do surgery in the following ways.

• Cutting out one area of the lungs.
• Removing the entire lung and replacing it with other lungs.
• Once you move out of the danger zone, your doctor will provide treatment based on the cause of the disease.  

The results may be,

• Antibiotics for pneumonia
• Chemotherapy for lung cancer
• Steroids for highly serious conditions

Treatment for Non-massive Hemoptysis 

If you have Hemoptysis due to bronchitis, your doctor can suggest antibiotic medications. Most of the non-massive Hemoptysis is recovered only by giving antibiotic medications. The medication also includes cough medicine.

If you have the perilous habit of smoking, quit it immediately. This is the best way to swiftly recover from scant or non-massive Hemoptysis.

Difference between Hemoptysis and Hematemesis

Hemoptysis Vs Hematemesis

Characteristics	Hemoptysis	Hematemesis
Definition	Coughing up of blood	Vomiting up of blood
Blood colour	Blood in bright red colour	Blood in dark red or brown colour
Disease type	Lung disease	Gastric disease or Hepatic disease
Nauseahttps://www.starhealth.in/blog/nausea-vomiting	Absence of Nausea	Presence of Nausea
Symptoms	Cough, chest pain	Nausea, tarry stools
pH of expectorated blood	Alkaline	Acidic
Anaemia	Common	Frequent
Appearance of blood	Frothy	Rarely frothy
Asphyxia	Asphyxia possible	Uncommon Asphyxia

Hemoptysis in Covid patient

Hemoptysis is a rarely occurring disease for Covid patients, and its incidence gets relatively higher, closer to 13 percent in patients who are diagnosed with Pulmonary Emboli.

Covid-19 patients also have the chance of developing Hemoptysis with or without Pulmonary Emboli. However, researchers postulate that pulmonary Emboli should be ruled out for all Covid-19 patients diagnosed with Hemoptysis.

Is Hemoptysis Curable?

Hemoptysis becomes a life-threatening disease if left untreated for days, and it immediately requires rapid diagnosis and treatment. Patients who are diagnosed with massive Hemoptysis and moderate Hemoptysis should be hospitalised immediately, and treatment should be given at a fast pace. However, Idiopathic Hemoptysis often resolves on its own.

Summing up 

Coughing up blood can be due to serious medical conditions, and it cannot be only due to Hemoptysis.

Talk to your healthcare provider if you cough up blood for longer than a week. Once you consult your doctor, they will determine the cause of your Hemoptysis.

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