A little blood in coughed up mucus

Last updated on 29 March 2021

Coughing up blood (blood in phlegm)

Coughing up blood can be a scary experience, but it is not always a sign of a serious issues in a person who is young and otherwise healthy.

It may appear as small amounts of bright red blood or frothy blood-streaked phlegm. The blood is usually from your lungs and is often the result of prolonged coughing or a chest infection. However, coughing of blood clots is potentially serious and you should see a doctor immediately.

In older people, coughing up blood is a cause for concern. This is especially so in those who smoke. Sometimes, blood that is dark and contains bits of food or what look like coffee grounds may be coming from the digestive system rather than lung. This is still a serious problem which needs to be medically evaluated.

Common causes of coughing up blood

Coughing blood-stained mucus (haemoptysis) can be a sign of a serious condition, Possible causes include:

• Bronchiectasis. Abnormally widened and damaged airways of the lungs making the lungs more vulnerable to infection
• Lung cancer. More likely to happen in those older than 40 and smoke tobacco. It causes a persistent cough, shortness of breath and chest pain
• Neck cancer. Starts in the throat, larynx or windpipe, causing a swelling or sore that does not heal, a permanent sore throat and a red or white patch in the mouth
• Pneumonia and other lung infections inflame the lung tissue causing bloody sputum
• Pulmonary embolism. A blood clot in the lungs, which usually causes sudden shortness of breath and chest pain
• Pulmonary oedema. Fluid in the lungs usually occurring in people with pre-existing heart problems
• Tuberculosis. A severe lung infection associated with fever and sweating
• Anticoagulants. Medications that prevent the blood from clotting, such as warfarin

When is coughing blood an emergency?

A cough that produces pink and frothy sputum, especially when it is associated with breathlessness, is a warning sign to go to the Accident & Emergency immediately as it indicates fluid overload in your lungs and is potentially fatal.

Seek immediate medical attention at the hospital if you experience any of the additional symptoms:

• Blood in mucus for more than a week, or bleeding that gets worse
• Chest pain
• Weight loss
• Night sweats
• A body temperature of 38°C or higher
• Shortness of breath during normal activity

During a medical emergency in Singapore, you can also call +65 6473 2222 for an ambulance that will transport you to the nearest hospital or a hospital of your choice. Learn more about Parkway Emergency services.

Infographic reviewed by
Dr Kenneth Chan, respiratory physician at Gleneagles Hospital
Dr Quah Hak Mien, general surgeon at Gleneagles Hospital

Infographic brought to you by Health Plus

References

Coughing Up Blood (Hemoptysis). N.D. Retrieved 31 August 2018 from https://www.webmd.com/lung/coughing-up-blood#1

Coughing up blood (blood in phlegm). N.D. Retrieved 31 August 2018 from https://www.nhs.uk/conditions/coughing-up-blood/

Coughing up blood. N.D. Retrieved 31 August from https://www.mayoclinic.org/symptoms/coughing-up-blood/basics/causes/sym-20050934

Coughing up blood: when should you be concerned. 13 January 2017. Retrieved on 3 September 2018 from https://www.health24.com/Medical/Cough/About-cough/Coughing-up-blood-when-should-you-be-concerned-20150422

Does a Colonoscopy Hurt? (2020, January 03) Retrieved December 04, 2020, from https://www.healthline.com/health/is-a-colonoscopy-painful

Considerations

Coughing up blood is not the same as bleeding from the mouth, throat, or gastrointestinal tract.

Blood that comes up with a cough often looks bubbly because it is mixed with air and mucus. It is most often bright red, although it may be rust-colored. Sometimes the mucus contains only streaks of blood.

The outlook depends on what is causing the problem. Most people do well with treatment to treat the symptoms and the underlying disease. People with severe hemoptysis may die.

Causes

A number of conditions, diseases, and medical tests may make you cough up blood. These include:

• Blood clot in the lung
• Breathing food or other material into the lungs (pulmonary aspiration)
• Bronchoscopy with biopsy
• Bronchiectasis
• Bronchitis
• Lung cancer
• Cystic fibrosis
• Inflammation of the blood vessels in the lung (vasculitis)
• Injury to the arteries of the lungs
• Irritation of the throat from violent coughing (small amounts of blood)
• Pneumonia or other lung infections
• Pulmonary edema
• Systemic lupus erythematosus
• Tuberculosis
• Very thin blood (from blood thinning medicines, most often at higher than recommended levels)

Home Care

Medicines that stop coughing (cough suppressants) may help if the problem comes from heavy coughing. These medicines may lead to airway blockages, so check with your health care provider before using them.

Keep track of how long you cough up blood, and how much blood is mixed with the mucus. Call your provider any time you cough up blood, even if you do not have any other symptoms.

When to Contact a Medical Professional

Get medical help right away if you cough up blood and have:

• A cough that produces more than a few teaspoons of blood
• Blood in your urine or stools
• Chest pain
• Dizziness
• Fever
• Lightheadedness
• Severe shortness of breath

What to Expect at Your Office Visit

In an emergency, your provider will give you treatments to control your condition. The provider will then ask you questions about your cough, such as:

• How much blood are you coughing up? Are you coughing up large amounts of blood at a time?
• Do you have blood-streaked mucus (phlegm)?
• How many times have you coughed up blood and how often does it happen?
• How long has the problem been going on? Is it worse at some times such as at night?
• What other symptoms do you have?

The provider will do a complete physical exam and check your chest and lungs. Tests that may be done include:

• Bronchoscopy, a test to view the airways
• Chest CT scan
• Chest x-ray
• Complete blood count
• Lung biopsy
• Lung scan
• Pulmonary arteriography
• Sputum culture and smear
• Test to see if the blood clots normally, such as PT or PTT

References

Brown CA. Hemoptysis. In: Walls RM, Hockberger RS, Gausche-Hill M, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 9th ed. Philadelphia, PA: Elsevier; 2018:chap 21.

Swartz MH. The chest. In: Swartz MH, ed. Textbook of Physical Diagnosis: History and Examination. 8th ed. Philadelphia, PA: Elsevier; 2021:chap 13.

Version Info

Last reviewed on: 4/21/2021

Reviewed by: Michael M. Phillips, MD, Emeritus Professor of Medicine, The George Washington University School of Medicine, Washington, DC. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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