Hemoptysis

Hemoptysis is the expectoration, or coughing up of blood, from the lower respiratory tract.

Distinguishing between minor, moderate and massive hemoptysis is important, as severity determines the need for emergency treatment. Minor hemoptysis is defined as small specks of blood or clots in the patient's sputum and is generally not life threatening. Moderate hemoptysis can include larger clots up to the loss of 200 mL of blood within a 24 hour period. Finally, massive hemoptysis is anything greater than a loss of 200 mL of blood within 24 hours and is always a medical emergency, as patient asphyxiation can occur rapidly.

Hemoptysis can be caused by many illnesses and conditions, but is most commonly seen in bronchitis, pneumonia, tuberculosis and lung cancer.

Patient history, including any occupational exposure, recreational drug use, chronic medical conditions or childhood infections of tuberculosis or pneumonia, is very important in diagnosing hemoptysis. A complete physical examination of the upper airway, cardiovascular work up, chest x-rays and blood coagulation studies may also be used in finalizing diagnosis. Procedures such as fiberoptic bronchoscopy, testing on expectorated sputum, chest CT scans and arterial blood gas analysis may also be performed.

Treatment for hemoptysis includes management of symptoms, control of blood loss and localizing the source of bleeding. Minor hemoptysis is usually mild and self-limiting and often requires only cough suppression. Patients with moderate hemoptysis may be hospitalized to receive oxygenation and narcotic cough suppressant while evaluation is performed.

Airway management is the primary concern in treatment of massive hemoptysis. Patients are evaluated quickly by a team of pulmonary, thoracic surgery, anesthesia and radiology physicians for intubation and bronchoscopy procedures. The massive hemoptysis patient will be placed in an ICU unit and kept on bed rest until the bleeding resolves.

'Hemoptysis' Sources:
  1. Johnson, John L. "Manifestations of Hemoptysis." Postgraduate Medicine, October 2002, Vol. 112, Issue 4, p. 101-109.
  2. Snowdrift Pulmonary Conference. "Monograph : Frontline Assessment of Common Pulmonary Presentations." 2001. pp. 52-62
  3. Ladwig, Jason R. "Hemoptysis: A review of causes, evaluation, and treatment -- How to quickly zero in on the diagnosis." Journal of Respiratory Diseases, 28.4. April 1, 2007. p. 139




 

 

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