Coughing up blood, irrespective of the amount, is an alarming symptom and patients nearly always seek medical advice. Care should be taken to establish that it is true hemoptysis and not hematemesis, or gum or nose bleeding. Coughing out of blood includes both blood-stained sputum and frank hemoptysis. Massive hemoptysis is defined as 600–800 mL of blood in 24 hours. Many episodes of hemoptysis remain unexplained, even after full investigation, and are likely to be due to simple bronchial infection. A history of repeated small hemoptysis, or blood streaking of sputum, is highly suggestive of lung cancer. Fever, night sweats and weight loss suggest tuberculosis. Pneumococcal pneumonia often causes ‘rusty’-colored sputum but can cause frank hemoptysis, as can all suppurative pneumonic infections, including lung abscess. Bronchiectasis and intracavitary mycetoma can cause catastrophic bronchial hemorrhage, and in these patients there may be a history of previous tuberculosis or pneumonia in early life. Finally, pulmonary thromboembolism is a common cause of hemoptysis and should always be considered.
Hemoptysis, Thromboembolism, Leukemia, Cancer etc
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