Haemoptysis refers to coughing up blood or blood-streaked mucus from your lower respiratory tract, namely, your throat and lungs1. It is not a disease itself but rather an indication of disease in the respiratory tract. It is an alarming condition and can be caused by quite a number of respiratory conditions. The amount of blood that is coughed up can range from streaks in mucus which amount to less than a teaspoon to as much as 600ml. Haemoptysis can be categorised into two types based on the amount of blood expelled within 24 hours, these are1:
Massive haemoptysis: also known as life-threatening haemoptysis, amount of blood coughed up ranges from 100-600ml.
Non-massive haemoptysis: also known as submassive or moderate haemoptysis, amount of blood coughed up ranges from 20-200ml.
The colour of the blood ranges from bright red and frothy to dark brown with the consistency of ground coffee.
What causes Haemoptysis (Coughing Blood)?
The causes of haemoptysis range from mild to life-threatening, these causes are2:
Bronchiectasis: the most common cause of haemoptysis, damaged airway walls that lead to inflamed and thickened airways.
Pneumonia: acute infection of the respiratory tract where the alveoli or air sacs get filled with fluid or pus, making it difficult to breathe.
Bronchitis: infection of the bronchi resulting in inflammation of the airways.
Tuberculosis: one of the deadliest infectious diseases in the world, it is often associated with coughing up blood.
Cystic fibrosis: excess mucus in the lungs and airways.
Vasculitis: inflammation of blood vessels.
Complications of lupus: lupus is an autoimmune disease.
Congestive heart failure: chronic condition that worsens over-time.
Lung cancer: abnormal cell growth in the bronchi, bronchioles, or alveoli.
What are the common symptoms of Haemoptysis (Coughing Blood) in Singapore?
Haemoptysis is a symptom itself – coughing up blood. If other issues occur in conjunction with it, then they would be symptoms of the main cause of haemoptysis.
The blood of haemoptysis can take on different appearances such as:
Streaked in mucus: often associated with tuberculosis, bronchiectasis, cystic fibrosis.
Pink and frothy: often associated with pulmonary oedema.
Pure blood: associated with tuberculosis or broken blood vessels.
Pay attention to the appearance of your haemoptysis, this will help in the proper diagnosis of your condition.
Is Haemoptysis painful?
It can be if the underlying cause of your haemoptysis causes pain. The most common pain one might experience is chest pains.
Who is at risk of Haemoptysis (Coughing Blood) in Singapore?
There are several risk factors associated with haemoptysis, these are:
Smoking: the number risk factor for all conditions related to the respiratory tract.
COPD: a chronic condition that can cause substantial damage to the respiratory tract which can increase your risk of coughing up blood.
Anticoagulant medication: medicines that prevent blood clots, which could lead to bleeding since wounds are not able to heal properly.
How is Haemoptysis (Coughing Blood) diagnosed?
If your respiratory specialist suspects haemoptysis after studying your medical history and conducting a physical examination, the following diagnostic tests may be conducted to identify the underlying cause of it:
X-ray: a chest x-ray can check for lung cancer, pneumonia, bronchiectasis, bronchitis, or other lung conditions.
Computed tomography scans (CT-scans): like an x-ray but with more accurate views, it may also be used to check for signs of various lung conditions.
Bronchoscopy: a long, thin tube with a light and camera attached at one end will be inserted into your throat and gently guided down to your lungs.
Blood test: checks the complete blood count which measures the amount of red and white blood cells in your body, together with platelets (helps with clotting).
Coagulation test: checks to see how well your blood clots.
Arterial blood gas analysis: checks the levels of oxygen and carbon dioxide in your blood which is a direct relation to how well your lungs are functioning.
Pulse oximetry: sensor is placed on your finger to check the oxygen levels in your blood.
Kidney function test or urinalysis: to check for autoimmune disorders that may affect your kidneys and lungs.
What are the treatment options for Haemoptysis (Coughing Blood) in Singapore?
Treatment depends on the underlying cause and how much blood is being lost. If the underlying cause is mild, then observation or a dose of antibiotics would suffice. However, if the cause is much more severe, then treatment options may include:
Surgery
Bronchoscopy
Steroids
Endovascular embolization
Chemotherapy
Frequently asked questions
Can haemoptysis cure on its own?
If it is mild enough, haemoptysis might disappear on its own. For severe cases, treatment is focused on alleviating symptoms and preventing advancement of the condition.
References
John Scott Earwood, T. D. (2015). Hemoptysis: evaluation and management. American Family Physician, 243-249.
