Coughing Up Blood (Hemoptysis): Causes, Diagnosis and Treatment in Malaysia

Coughing Up Blood (Hemoptysis): Causes, Diagnosis and Treatment in Malaysia

Table of Contents

What is Coughing Up Blood or Hemoptysis?

Coughing up blood, medically referred to as hemoptysis, can present itself in various ways. Some patients might experience it quite severely, coughing up substantial amounts of blood or blood clots. In extreme cases, the volume of blood can even amount to half a cup, a full cup, or more.

On the other hand, some people may notice only minimal blood streaks in their phlegm when they cough. This too is classified as coughing up blood. Others might describe their phlegm as having a pinkish hue when they cough, which is also a form of hemoptysis.

To ensure accurate diagnosis and treatment, it’s crucial to describe your symptoms clearly and thoroughly to your doctor. This allows medical professionals to fully understand your situation and identify the exact cause of your condition.

When is Coughing Up Blood a Cause for Concern?

The seriousness of coughing up blood, or hemoptysis, largely depends on the volume and frequency of blood in your phlegm. If you find yourself coughing up several cups of blood, this is indeed a serious condition that requires immediate attention.

On the other hand, an occasional cough with minimal blood streaks may not be as severe. However, if this occurrence persists over a prolonged duration, it should not be ignored. Medical investigation is necessary to determine the cause of the blood streaks in your phlegm.

If you are coughing up a significant amount of blood, it’s crucial to contact emergency medical services or go to the emergency department of your nearest hospital promptly. The same applies if your phlegm is pinkish in color or contains blood streaks, as these symptoms also warrant urgent medical attention.

Always consult with your doctor for appropriate assessment and to determine the next steps if you experience any form of hemoptysis.

Potential Complications from Coughing Up Blood

Persistent and severe coughing up of blood can lead to multiple complications, including significant blood loss. This could cause a condition known as anemia, characterized by low haemoglobin levels. Symptoms of anemia can include shortness of breath, a rapid heartbeat (palpitations), dizziness, and potential fainting or loss of consciousness.

Further complications can arise if the coughed-up blood enters back into the lungs, resulting in asphyxia or choking on your own blood. This condition can severely impact your breathing, leading to low oxygen levels in your body. If left untreated, it could even be life-threatening.

Therefore, if you’re coughing up substantial amounts of blood – about half a liter or one to two cups a day – it is an emergency situation requiring immediate medical attention.

Causes of Coughing Up Blood

Numerous lung diseases can result in coughing up blood. More severe conditions include tuberculosis, lung infections, lung cancer, pneumonia, and bronchiectasis. These are some of the common culprits behind coughing up blood.

At times, prolonged coughing due to conditions like reflux or uncontrolled asthma can lead to coughing up blood. The forceful coughing might injure the throat, resulting in blood streaks in the phlegm.

Other causes to consider include acute pulmonary edema, which can cause blood to appear in the phlegm. It’s crucial to consult with your doctor and undergo a thorough check-up to identify the precise cause of the blood in your phlegm or any instances of coughing up blood.

How to Diagnose the Cause of Hemoptysis (coughing up blood)

To diagnose the cause of hemoptysis, several tests are necessary. First and foremost, chest X-rays and imaging are needed to determine any significant lung involvement or heart enlargement. Blood tests also play a crucial role in checking for signs of severe lung infection, viral infection, TB infection, or cancer.

Additionally, it’s essential to check the coagulation profile, which indicates the blood’s clotting ability. People with blood clot disorders can also present with blood in their phlegm.

CT scans are another vital part of the diagnostic process. These can help identify the source of bleeding from the lung vessels that result in blood appearing in the phlegm.

Finally, you may require a bronchoscopy. In this procedure, a small camera is inserted through the nose and throat into the lungs. This allows doctors to observe the inner part of the lung, locate the exact source of the bleed, and halt the bleeding. These are the primary tests employed to identify and treat the cause of blood in your phlegm.

Treatment for Coughing Up Blood

The treatment for coughing up blood, or hemoptysis, depends on the underlying cause. If tuberculosis (TB) is the root of the problem, the patient will require anti-TB treatment. If lung cancer is the cause, treatment options depend on the stage of the disease. Early-stage cancer may be treatable with surgery, while later-stage cancer could necessitate chemotherapy or radiotherapy.

If the hemoptysis is due to a lung infection, the patient will need antibiotics. Medications like Tranexamic acid can also be prescribed to prevent further episodes of coughing up blood.

In some cases, bronchial artery embolization may be considered. This procedure involves injecting a substance, often a type of medical “glue,” into the bleeding vessels causing the presence of blood in the phlegm. However, this requires the expertise of an interventional radiologist, and the patient would first need a CT angiogram to make this decision.

What Immediate Action to Take if you Cough Up Blood?

If you experience coughing up blood, coupled with symptoms such as dizziness and difficulty breathing, it’s crucial to seek immediate medical attention. Go to the hospital right away or call an ambulance if you don’t have transportation. This is considered an emergency.

In preparation for potential diagnostic tests, avoid eating. An urgent CT scan is often necessary to identify the source of the bleeding, and this requires you to have an empty stomach for at least two to four hours to ensure the accuracy of the scan.

A bronchoscopy may also be performed, which involves inserting a small camera through the nose, down the throat and into the lungs. This allows doctors to wash out the bleeding area, identify the source of the bleeding, and attempt to stop it. As with a CT scan, it’s important to be fasted, preferably for four to six hours, before a bronchoscopy.

Conclusion: Understanding and Managing Hemoptysis

In conclusion, hemoptysis, or coughing up blood, is a symptom that can take different forms and severities. It can range from minor blood streaks in phlegm to coughing up significant amounts of fresh blood. While minor instances may be less severe, if they persist over time, they should still be examined by a healthcare professional.

Hemoptysis can lead to serious complications if not managed properly. These complications can include anemia, asphyxia, and potentially life-threatening conditions. Hence, any significant or persistent occurrence of coughing up blood should be treated as a potential emergency.

The root cause of coughing up blood can be various lung diseases, including tuberculosis, lung infection, lung cancer, bronchiectasis, or even the result of prolonged coughing due to other conditions like uncontrolled asthma or reflux.

Diagnosing hemoptysis involves a suite of medical tests, such as chest x-rays, blood tests, coagulation profiles, CT scans, and bronchoscopies, which aid in identifying the source of the bleeding and planning the appropriate treatment strategy.

The treatment of hemoptysis is contingent on the underlying cause. This could range from anti-TB treatment, antibiotics for lung infections, or even chemotherapy or radiotherapy for lung cancer.

In the event of coughing up blood, especially alongside symptoms like dizziness or difficulty breathing, it’s crucial to seek immediate medical attention. Procedures like bronchoscopies may be necessary and require patients to fast, so avoiding eating if you need to go to the hospital is recommended.

In summary, while coughing up blood can be alarming, understanding the possible causes, the procedures used to diagnose these causes, and the subsequent treatment options can make managing this symptom more approachable. If you experience hemoptysis, seek immediate medical attention to ensure your health and safety.

If you require assistance for coughing up blood,
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Dr. Nurul Yaqeen

Consultant Respiratory, Internal Medicine Physician, Sleep Disorders Specialist


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