| Hemoptysis is the symptom of coughing up blood or blood-streaked phlegm (sputum) originating in the respiratory tract. The bloody substances may appear bright red or may look frothy because it is mixed with air from the lungs. The amount of blood expelled may be related to the severity of the underlying condition.
The source of hemoptysis may be bleeding in the lung circulation system (pulmonary vessels or bronchial vessels) or the tissue (granular). Inflammatory conditions of the airways (bronchitis, bronchiectasis, laryngitis) account for about 80% to 90% of hemoptysis cases. Primary tumors (especially carcinoma) of the lung account for about 20% of cases (Beers). These tumors are most common in persons over 40 years old who are smokers. However, lung cancers that have spread from other primary sites (metastatic lung cancers) rarely cause hemoptysis.
Other causes of hemoptysis are inflammatory lesions of the lung such as tuberculosis or pulmonary emboli. The autoimmune disorders of systemic lupus erythematosus, Goodpasture's syndrome, and Wegener's granulomatosis, may also have the symptom of hemoptysis. An inherited lung disease, cystic fibrosis, can be an underlying cause of the condition. Occasionally, hemoptysis results from lung trauma following medical procedures (bronchoscopy, lung biopsy, pulmonary artery catheterization). However, in 30% to 40% of cases, the exact cause of hemoptysis is not found (Beers).
Other symptoms accompanying hemoptysis may give clues about underlying causes, such as unexplained weight loss possibly indicating cancer or such as the presence of pus-filled (purulent) sputum being linked to infection. Some biological weapons that potentially could be used by terrorists cause hemoptysis, including plague, tularemia, and T2 mycotoxin.Risk: Smoking may be a contributing factor to development of underlying conditions causing hemoptysis. Incidence and Prevalence: Worldwide, tuberculosis is a primary cause of hemoptysis. About 2 billion people are estimated to be infected with tuberculosis, and about 5% to 10% of that population likely will develop hemoptysis. Bronchial diseases are the most common cause of hemoptysis in the US. Up to half of all hemoptysis cases in industrialized countries are related to acute and chronic bronchitis (Corder). |
Source: Medical Disability Advisor
| History: In addition to reporting the symptom of coughing up blood, the individual may complain of fever, night sweats, weight loss, loss of appetite, difficulty breathing or chest pain. Individuals may report a history of lung infections, cancer, or cigarette smoking. It is important to obtain an occupational history on the client to assess for exposure to lung carcinogens such as asbestos and nickel. Physical exam: Depending on the cause of hemoptysis, the physical exam may reveal pain over the sinuses or inflammation of the nose or throat. Abnormal lung sounds such as wheezes, crackles, or diminished breath sounds may be present. Distended neck veins, generalized swelling of extremities, extra heart sounds and poor color are other possible associated findings. Presence of localized pain or masses may suggest tumors. Tests: Tests should be aimed at determining the underlying cause of the hemoptysis. A chest x-ray (radiograph) generally is a major step to help detect presence of possible lung disease. Sputum may be collected and analyzed to check for bacteria, tuberculosis, or malignancy. Coagulation studies, arterial blood gases, CT scan, BUN/creatinine, and serologic studies may be performed. Bronchial arteriography to help localize the site of bleeding may be used. Tracking movement of radioactive material through the lung circulatory system and analyzing the individual's ability to breathe through inhalation of radioactive gases (pulmonary ventilation-perfusion scan) also may help detect any underlying conditions. CT or magnetic resonance imaging (MRI) may detect lung or other body system masses or lesions. |
Source: Medical Disability Advisor
| Effective treatment depends on the underlying cause of hemoptysis. Therapy should focus on stopping the bleeding, controlling cough, preventing any spread of infection and alleviating the individual's fear and apprehension.
Often mild bleeding stops spontaneously. However, massive or continuous bleeding, greater than 24.5 to 36.5 cubic inches (400 cc to 600 cc) in 24 hours, can be life-threatening and requires immediate intervention. Bronchial artery embolization is one intervention used to control massive lung bleeding. Laser therapy is another treatment modality to arrest bleeding in those with massive hemoptysis. Surgical intervention (thoracotomy) may be considered for individuals with massive bleeding from an identifiable lung lesion.
The cough may be treated with respiratory therapy and medications to reduce inflammation or treat and control an infection. Sedatives and narcotics are avoided, since they can depress respirations. |
Source: Medical Disability Advisor
| Depending on the underlying cause, the outcome of hemoptysis is generally good, with most individuals surviving. However, those with bleeding disorders usually have a greater amount of bleeding and a higher mortality rate, probably due to the difficulty in controlling the bleeding. Only about 1.5% of all cases of hemoptysis are considered extremely severe or massive (Corder). Individuals with cancer have a high mortality rate, often due to the complication of infection rather than the initial bleeding.
Outcomes of bronchial artery embolization and surgical treatments depend on the extent of the underlying condition being treated. Complications of infection, bleeding and respiratory failure could cause death. |
Source: Medical Disability Advisor
| Massive blood loss may lead to a decline in oxygen (asphyxia), shock, and anemia. |
Source: Medical Disability Advisor
| Any work restrictions and accommodations will depend on the cause of hemoptysis. Those who have residual shortness of breath may require modified duty with frequent rest breaks. |
Source: Medical Disability Advisor
| If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case. Regarding diagnosis:
- Has the cause of the hemoptysis been identified?
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Is bleeding recurrent or significant?
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Has bronchoscopy or perfusion scan been done to identify the bleeding point?
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Does individual have an underlying condition that may impact recovery?
Regarding treatment:
- If bleeding stopped spontaneously, has it recurred?
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Does source need to be identified or re-evaluated?
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Has individual been considered for a pulmonary rehabilitation program?
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Was procedure successful in resolving the bleeding? Is additional therapy required?
Regarding prognosis:
- Has hemoptysis recurred despite treatment of underlying condition?
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Does bleeding source need more aggressive resolution?
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Would individual benefit from evaluation by a specialist or enrollment in a pulmonary rehabilitation program?
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Does individual have an underlying disorder that may impact recovery?
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Source: Medical Disability Advisor
| Beers, Mark H., and Robert Berkow, eds. "Hemoptysis." The Merck Manual of Diagnosis and Therapy. 17th ed. Merck and Company, Inc., 2004. Merck. Merck & Co., Inc. 21 Dec. 2004 <http://www.merck.com/mrkshared/mmanual/section6/chapter63/63g.jsp>.Corder, R. "Hemoptysis." Emergency Medical Clinics of North America 21 2 (2003): 421-435. MD Consult. Elsevier, Inc. 21 Dec. 2004 <http//home.mdconsult.com/das/journal/view/38456461-2/N/13101092?sid=278140390&source=MI>. |
Source: Medical Disability Advisor
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