Coughing Up Blood

What is coughing up blood (hemoptysis)?

Coughing up blood involves coughing or spitting up blood or bloody mucus from your lower respiratory tract (lungs and throat). Also called hemoptysis (pronounced “he-MOP-tih-sis”), coughing up blood is common and can have many causes. Most causes aren’t serious. However, you may need to visit an ER immediately if you’re coughing up large amounts of blood.

Blood that you cough up often looks bubbly or frothy and is mixed with mucus or spit. It can appear pink, red or rust-colored and is usually in small amounts.

What is the difference between coughing up blood and vomiting blood?

Coughing up blood (hemoptysis) isn’t the same as vomiting blood (hematemesis). Blood that’s coughed up usually looks like blood-stained spit mixed with mucus. The blood comes from your throat or mouth. Vomiting blood involves spewing large quantities of blood. It usually involves internal bleeding in your upper gastrointestinal (GI) tract.

See a healthcare provider immediately if you’re vomiting blood.

Is coughing up blood serious?

It can be. It all depends on what’s causing your blood loss and the extent of your blood loss. Most causes aren’t serious and are treatable. Still, coughing up blood can be a sign of serious conditions, like a severe infection or lung cancer. Losing too much blood at once can be life-threatening and require emergency medical attention.

Only a healthcare provider can determine how serious your condition is. If you’re coughing up large quantities of blood, or if your condition doesn’t improve, see a provider.

What causes coughing up blood?

Causes range from mild (most common) to serious and potentially life-threatening. Usually, coughing up blood is related to an infection. The most common causes include:

• Bronchitis.
• Pneumonia.
• Tuberculosis.

Other causes include:

• Bronchiectasis.
• Cystic fibrosis.
• Vasculitis.
• Drug use (crack/cocaine).
• Complications from lupus.
• Congestive heart failure.
• Injury to the arteries in your lungs.
• Irritation from a bronchoscopy biopsy.
• Using blood thinners (anticoagulants).
• Excessive coughing that irritates your throat.
• Blood clot in your lung (pulmonary embolism).
• Chronic obstructive pulmonary disease (COPD).
• Pulmonary aspiration (breathing blood into your lungs).
• Lung cancer (especially in people over 40 who smoke).
• Blood entering your throat from your nose (nosebleed), tonsils or teeth.
• Foreign body or obstruction in your airway (more common among children).

How do healthcare providers diagnose what’s causing you to cough up blood?

Your healthcare provider will review your medical history, perform a physical exam and ask questions to determine what’s causing you to cough up blood. They may ask:

• How much blood you’ve been coughing up.
• How often you’ve been coughing up blood.
• How long you’ve been coughing up blood.
• How much blood is mixed with mucus or spit.

Your healthcare provider may also ask about behaviors that put you at risk, like drug use or smoking. They may try to identify potential causes by asking about other symptoms you’ve been experiencing.

They may perform any of the following tests to diagnose the underlying cause:

• A chest X-ray to look for tumors or fluid in your lungs.
• A computed tomography (CT) scan of your chest to investigate findings from the X-ray or accompany an additional procedure, like a bronchoscopy.
• A bronchoscopy to check if your airways are clear and locate the site where the bleeding’s occurring.
• A complete blood count (CBC) to assess how much blood you’ve lost and look for signs of infection.
• A sputum culture of your lung excretions to look for infectious causes that may be causing you to cough up blood, like bacteria or viruses.
• A blood clotting test (coagulation test) to see if a bleeding disorder is related to your symptoms.
• Pulmonary arteriography to see how blood flows through your lungs.
• A urinalysis and/or kidney function test to rule out autoimmune conditions that affect your lungs and kidneys.

Your provider may perform additional procedures or order other tests depending on what they suspect is causing you to cough up blood.

How is coughing up blood treated?

Treatment depends on how serious your blood loss is and what’s causing you to cough up blood.

If you’re experiencing severe blood loss, you’ll receive care in the intensive care unit (ICU). Your care team will work to stabilize you and stop the bleeding before proceeding to diagnose what’s causing your blood loss.

Treatments for severe blood loss related to coughing up blood may include:

• A bronchoscopy to remove clots in your airways that may be causing the bleeding.
• Bronchial artery angiography and embolization to stop blood flow in blood vessels that are causing your bleeding.
• Medicine that’s used to stop bleeding related to severe blood loss (tranexamic acid).

Once they determine what’s causing you to cough up blood, your healthcare provider will discuss the best treatment plan to address your symptoms and underlying condition.

Treatments to address conditions that may cause you to cough up blood include:

• Antibiotics: If pneumonia or tuberculosis is causing your condition.
• Steroids: If inflammation is causing your condition.
• Surgery and cancer treatment: If a malignant (cancerous) tumor is causing your condition.

What should I do if I am coughing up blood?

Coughing up blood can be a sign of a serious medical condition. Seek emergency care if you’re coughing up large quantities of blood.

If you're coughing up small amounts of blood for longer than a week, make an appointment with a healthcare provider. They’ll determine what’s causing your hemoptysis and get you the necessary treatment.

Should I go to the ER if I’m coughing up blood?

Seek immediate medical attention if you’re coughing up more than a few teaspoons of blood, if you’ve been coughing up blood longer than a week or if your cough is accompanied by other symptoms, including:

• Fever.
• Chest pain.
• Night sweats.
• Shortness of breath.
• Rapid or severe weight loss.
• Dizziness or light-headedness.
• Blood in your urine (hematuria) or stools.

A note from Cleveland Clinic

Don’t panic if you’re coughing up small amounts of blood. The most common causes are treatable. If you’re losing large amounts of blood, your condition isn’t improving and you have other symptoms, see a healthcare provider immediately. It’s important to know what’s causing this symptom so you can get the care you need. Regardless of the cause, the sooner you receive treatment, the better.