Coughing up blood, medically termed hemoptysis, is the expectoration of blood originating from the lower respiratory tract, including the lungs and airways. While the sight of blood can be alarming, the causes range from minor irritation to severe underlying conditions. Regardless of the volume, this symptom always warrants immediate medical evaluation to determine the source and assess potential risks.
Immediate Indicators for Emergency Care
The primary concern with hemoptysis is the potential for massive blood loss or, more commonly, airway obstruction, which demands an immediate 911 call or emergency department visit. If you are coughing up more than a few teaspoons of blood, or if the bleeding is continuous, seek emergency care immediately.
A large volume of bleeding, defined as more than 200 to 600 milliliters over 24 hours, is classified as massive hemoptysis and is considered life-threatening. This amount is roughly equivalent to a full cup of blood and represents a serious risk of asphyxiation. Even smaller volumes, such as 50 milliliters, can be dangerous if a person has underlying cardiopulmonary issues.
The presence of accompanying symptoms is equally important. Seek immediate help if the blood is coupled with severe shortness of breath or difficulty breathing, suggesting a compromise of the airway or lung function. Other concerning signs include severe chest pain, dizziness, or lightheadedness, which may indicate a rapid drop in blood pressure or a serious pulmonary event.
A rapid heartbeat, fever, or any sign of shock, such as pale skin or confusion, signals a severe systemic reaction requiring urgent stabilization. Individuals with clotting disorders, those taking blood-thinning medications, or patients with certain cancers should treat even moderate bleeding with heightened caution, as the risk of life-threatening events is increased in these groups.
Distinguishing the Source and Severity of Bleeding
Not all blood coughed up originates from the lower respiratory tract; sometimes, it is pseudo-hemoptysis, which comes from the nose, mouth, throat, or gastrointestinal (GI) tract. Differentiating the source can help assess the urgency, although any uncertainty warrants professional evaluation. True hemoptysis, from the lungs, is characteristically bright red, often frothy or bubbly due to being mixed with air, and is alkaline in pH.
In contrast, blood from the stomach, known as hematemesis, is typically darker, acidic, and may have a “coffee-ground” appearance due to partial digestion. This GI bleeding is often preceded by nausea and may be mixed with food particles, whereas hemoptysis is typically preceded by a cough. Bleeding from the upper airway, such as a nosebleed that drains down the throat, can also mimic hemoptysis, but it usually involves clots and is not frothy.
Minor instances of bleeding, such as small streaks or flecks of blood mixed with mucus, are common, particularly with persistent, forceful coughing due to infections like bronchitis. While these small amounts are less likely to represent an immediate life-threatening situation, they still require follow-up with a primary care provider or urgent care. If the minor bleeding persists for more than a week, or if the source remains unidentified, a full medical workup is necessary.
Essential Information to Gather Before Medical Evaluation
Gathering specific information significantly aids the medical team while preparing for an ER visit. Monitor the actual quantity of blood produced, noting the frequency of bleeding episodes. Use common household objects, like a teaspoon or a small cup, to estimate the total volume.
Medical providers will need a detailed history of your symptoms, including when the bleeding began and whether it followed a respiratory infection or trauma. Be prepared to list all current medications, especially blood thinners, and disclose any history of smoking or underlying lung conditions, such as chronic obstructive pulmonary disease or bronchiectasis. Information about recent travel is also relevant, as it can point toward less common infectious causes.
Remain calm and avoid aggressive coughing, which can potentially worsen the bleeding. Gather necessary documents, such as identification, insurance information, and a list of known medical conditions, to streamline the intake process at the emergency department.