Blood in the sputum is a joint event in many mild respiratory conditions, including upper respiratory infections and asthma. However, it can sometimes indicate a more severe problem, such as bronchitis or lung cancer. Doctors cannot identify a reason in around halfTrusted Source of all people who experience this.
Doctors distinguish between mild and massive hemoptysis. Mild hemoptysis is when sputum has a tinge of blood. This is usually minor. Massive hemoptysis is when a person produces between 100-1,000 millilitersTrusted Source of blood within 24 hours can be life-threatening.
Where does it come from?
A range of factors can lead to blood in the sputum.
The blood usually comes from the lungs but sometimes from the stomach or digestive tract. The medical term is hematemesis if the blood comes from the digestive tract.
If the blood is bright red, bubbly, and sometimes mixed with mucus, it probably comes from the lungs, as with hemoptysis, and can result from persistent coughing or a lung infection.
If the blood is dark and comes with traces of food, it probably originated in the stomach or elsewhere in the digestive tract, as with hematemesis.
Causes and symptoms
Here are some possible causes of blood in the sputum:
- Bronchitis involves persistent or recurring airway inflammation, a cough, and sputum production. It can be chronic or acute, lasting up to 3 weeks.
- Bronchiectasis describes a permanent enlargement of parts of the airways. It is a long-term condition that can cause shortness of breath and wheezing.
- A severe or chronic cough can irritate the upper respiratory tract and damage the blood vessels.
- Inhaling either cocaine or recreational drugs can irritate and damage the upper respiratory tract.
- Anticoagulants stop blood from clotting. Examples include warfarin, rivaroxaban, dabigatran, and apixaban.
- Chronic obstructive pulmonary disease (COPD) obstructs the airflow in the lungs and usually causes difficulty breathing, a cough, the production of sputum, and wheezing.
- Pneumonia involves inflammation of the lung tissue, usually because of a bacterial infection. Common symptoms include chest pain when breathing or coughing, fatigue, fever, sweating, and chills. Older adults can also experience confusion.
- A pulmonary embolism refers to a blood clot in an artery of a lung. It usually causes chest pain and sudden shortness of breath and is life-threatening.
- Pulmonary edema is when fluid is in the lungs. It is most common in people with heart conditions and causes pink and frothy sputum, shortness of breath, and chest pain.
- Lung cancer is most common in people with a history of smoking tobacco. Symptoms include a cough that does not go away, shortness of breath, chest pain, and sometimes, bone pain or headaches.
- Neck cancer usually starts in the throat, larynx, or windpipe. It can cause a sore or swelling that does not heal, a permanent sore throat, and a red or white patch in the mouth.
- Cystic fibrosis is an inherited condition that damages the lungs. It usually causes difficulty breathing and a persistent cough with thick mucus.
- Granulomatosis with polyangiitis involves inflammation of the blood vessels in the sinuses, lungs, and kidneys. It usually causes a runny nose, nosebleeds, shortness of breath, wheezing, and a fever.
- Tuberculosis (TB) is a bacterial infection that can lead to a fever, sweating, chest pain, breathing or coughing pain, and a persistent cough.
- Mitral valve stenosis involves a narrowing of the heart’s mitral valve. It can cause shortness of breath, swollen feet or legs, heart palpitations, and fatigue, particularly with increased physical activity.
- A severe injury or trauma to the chest can cause blood to appear in the sputum.
When to see a doctor
People should seek medical advice if they notice flecks or streaks of blood in their phlegm.
A person needs emergency care when:
- Coughing brings up a lot of blood.
- finding it hard to breathe
- having pain in their chest or upper back
- experiencing a rapid heartbeat
Diagnosis
A doctor will usually take Trusted Source a medical history and perform a physical examination to find out why blood is present in the sputum.
During the exam, a doctor may:
- ask the person to cough
- check the nose and mouth for bleeding
- take samples of sputum and blood for testing
Additional examinations are sometimes necessary, including a chest X-ray, CT scan, or bronchoscopy.
During a bronchoscopy, a doctor inserts an endoscope into the airway through the nose or mouth. An endoscope has a camera at the end of a tube, allowing a doctor to look for the cause of bleeding and treat it at the same time.
Treatment
Treatments aim to stop the bleeding and treat the underlying cause.
Depending on an individual’s needs, there is a comprehensive rangeTrusted Source of options. The approach will depend on the severity of the bleeding and the underlying cause.
Options for treatment may include:
- a doctor prescribing steroids to manage inflammation or antibiotics to resolve a bacterial infection, such as TB
- using tools to stop bleeding or remove a blood clot during a bronchoscopy
- needing a range of treatment approaches, including chemotherapy and radiation therapy, for people with lung or neck cancer
A person with severe bleeding may need trusted Source:
- Bronchial artery embolization: If blood in the sputum results from damage to a bronchial artery, a doctor will recommend an embolization procedure. A surgeon will pass a catheter into the vessel, identify the Source of the bleeding, and use a metal coil, chemical, or fragment of gelatin sponge to seal it.
- Vasoconstrictors: Drugs, such as vasopressin, can limit trusted Source bleeding by reducing the size of blood vessels.
- Blood product transfusion: If clotting problems lead to blood in the sputum, it may be necessary to transfuse elements in the blood, such as plasma, clotting factors, or platelets.
- Surgery: This may be necessary to remove a damaged or cancerous portion of the airways or digestive system. It is an option when bleeding is severe or persistent.
Severe bleeding in the airways can make it difficult to breathe. In this case, a person may need intubation and supplemental oxygen to help them live.
Outlook
A small amount of blood in the sputum is not usually a cause for concern. In 90%Trusted Source of people with mild hemoptysis, the underlying cause of blood in the phlegm will resolve independently.
If there is a lot of blood, the outlook may be more serious, as it may be a sign of severe damage to the airways or digestive system. Without treatment, the mortality rate may be as high as 80%Trusted Source because it can affect a person’s breathing ability. The individual will need immediate medical attention.
Sometimes, a person does not produce a lot of blood, but the bleeding is persistent. Bleeding for several weeks may indicate lung cancer or another severe illness. People who notice blood in their phlegm often should seek medical advice.
