Coughing up blood, otherwise known as hemoptysis, can be very frightening. But, it can also be confusing because you may not know where the blood is coming from. Is it coming from the nasal passages, the esophagus (feeding tube), the trachea (windpipe), the lungs, or your stomach?
While hemoptysis is a tell-tale sign of lung cancer, it is more often due to a benign cause.
This article looks at the possible causes and symptoms of hemoptysis as well as how the condition is diagnosed and treated. It also describes when coughing up blood can be a medical emergency.
Coughing up a third of a cup of blood has a mortality rate of around 30% to 50%. If you have coughed up a teaspoon of blood or more, call 911 immediately. Do not wait.
Many people describe the symptom as "spitting up blood" or having blood-streaked mucus. Blood that is coughed with phlegm will often have a bubbly appearance.
Depending on the underlying cause, there may also be accompanying symptoms like:
There are many different reasons why you may be coughing up blood. Some are more serious than others, but there is generally no way to tell by just looking at it or assessing how it feels. Coughing up blood in amount should be taken seriously.
Hemoptysis or Something Else?
It is important to make a distinction between coughing up blood from the respiratory tract and from other parts of the body. For example:
- Pseudohemoptysis is the coughing up of blood not from the lungs.
- Hematemesis is the vomiting of blood from the digestive tract.
Each is treated differently and can be difficult to tell apart. In many cases, only an evaluation from a healthcare provider can pinpoint the source of the bleeding.
Some possible causes of hemoptysis include:
Hemoptysis is the only symptom in only 7% of people diagnosed with lung cancer, and it's considered the symptom most specific for the diagnosis.
Causes in Children
Coughing up blood in children tends to have different causes than the same symptom in adults. The most common causes are infections, such as pneumonia, bronchitis, and tuberculosis.
Roughly a third of the time a cause cannot be determined and the symptom goes away without finding a cause (something referred to as "idiopathic".
Underlying heart disease is the second most common cause of hemoptysis in children.
When to Go to the Hospital
Coughing up blood can quickly become an emergency. Coughing up more than one teaspoon of blood is considered a medical emergency.
Coughing up 100 cubic centimeters (cc) of blood—1/3 of a cup—is called massive hemoptysis and has a mortality (death) rate of 30% to 50%. Don't try to drive yourself or have someone else drive you to the hospital—call 911.
The issue is that coughing up blood can quickly cause airway obstruction and infiltration of the blood into your lungs, leading to suffocation and death.
When to Call 911
Call 911 if you experience chest pain, shortness of breath, or lightheadedness even if you cough up just a trace of blood.
If you cough up blood—even a very small amount—it is important to make an appointment to see your healthcare provider.
If possible, bring a sample of what you have been coughing up to your appointment. Wrapping the sample in plastic wrap can preserve the sample better than wrapping it in tissue.
The diagnosis will involve a review of your medical history and a physical examination. The healthcare provider will not only examine your mouth and throat but listen for lung sounds using a stethoscope.
Based on the findings, your healthcare provider will recommend tests to help determine the cause. Possible tests may include:
- Lab tests to check your blood count and blood oxygen levels
- A chest X-ray to look for infection, obstruction, trauma, or a tumor
- A computed tomography (CT) scan of your chest
- A bronchoscopy (a flexible scope is inserted through the mouth and into the bronchi)
If you are actively bleeding, a CT scan is usually the imaging test of choice to evaluate bleeding.
It is important to be your own advocate and to keep asking questions if answers are not found. Lung cancers are often missed on chest X-rays and may require a chest CT scan to make the diagnosis, particularly if the tumor is small. If you aren't getting the answers you need, consider getting a second opinion.
This is important given that the average time between the onset of symptoms and diagnosis of lung cancer is 12 months. This is a span of time during which treatment can make a big difference in the outcome of the disease.
While it is important to find the underlying cause of hemoptysis, the symptom sometimes needs to be treated directly (and immediately) even if the cause is not entirely clear.
The first step in managing hemoptysis is to make sure the airway is protected. Intubation (the insertion of a breathing tube) may be necessary, especially with massive bleeding.
When the bleeding is mild, treatment may be focused on managing the underlying cause. Otherwise, the following options may be considered.
There are several techniques that can be used during a bronchoscopy to manage the bleeding, but these are most effective when the bleeding is mild or moderate.
- Endobronchial insertions: These are substances delivered via endoscopy to stop bleeding topically. Options include iced saline, cellulose, and a liver fiber known as fibrinogen.
- Argon photocoagulation: This is a technique used to form blood clots locally.
- Electrocautery: This is using electricity to burn tissues in order to seal a bleed.
- Endobronchial stent placement: This may be used to redirect blood flow after a bleed has been stopped.
Bronchial Artery Embolization
When the bleeding is very significant, bronchoscopic procedures are much less likely to be effective. At the current time, bronchial artery embolization is recommended as the first-line treatment of massive hemoptysis.
In this procedure, a catheter is inserted into an artery in the upper thigh and threaded up to the pulmonary artery in the lung. Various substances then may be used to embolize (cause a clot) in the artery, such as a gelatin sponge, PVC particles, or a metallic coil.
Surgery is needed less often than in the past for hemoptysis but is often still used in settings such as massive hemoptysis due to trauma.
A wedge resection (in which a wedge of lung tissue is removed and the cut ends are sewn together) is a common approach to treating massive hemoptysis. This may involve minimally invasive video-assisted thoracoscopic surgery or open surgery.
A Word From Verywell
Coughing up blood can be a frightening symptom, and the causes can be as mild as airway irritation from coughing, to as serious as lung cancer or a blood clot in the lungs. Even small amounts of bleeding into the lungs can be dangerous, due to the risk of aspiration (and asphyxiation). Coughing up only a teaspoon of blood is considered a medical emergency.
While frightening, even with active bleeding there is much that can be done. Bronchial artery embolization is often very effective in what could otherwise be a life-threatening situation.
While coughing up blood is the first symptom in only 7% of lung cancers, it's important to rule out this possibility in adults regardless of risk factors. As with other cancers, the earlier a lung cancer is diagnosed, the greater the chance of a cure.
Frequently Asked Questions
Is coughing up blood a sign of COVID?
Not typically. In rare instances, people do cough up blood. According to some reports, fewer than 1% to 5% of people admitted to the hospital for COVID suffer from this symptom. It has also been seen in people recovering from COVID-related pneumonia.
Why am I coughing up blood with bronchitis?
The blood may be from your nasal passages, throat, lungs, or airways, where blood vessels may tear by the force of coughing or irritation. If the amount of blood is very small, it shouldn’t be a problem, but let your doctor know so you can be sure it’s not a more severe lung infection.
Can medications cause you to cough up blood?
Yes. Blood thinners, also known as anticoagulants, can sometimes cause you to cough up blood. These medications include Coumadin (warfarin), Xarelto (rivaroxaban), and Pradaxa (dabigatran). Call your your doctor immediately if you experience this.