Haemoptysis

Haemoptysis is the expectoration of blood from the lower respiratory tract. The blood may appear as bright red spurts or as blood-tinged sputum. It is a symptom rather than a disease, and several conditions can cause it. Distinguishing haemoptysis from swallowing blood from the upper airway or from the gastrointestinal tract can be difficult, but typically the blood originates from the tracheobronchial tree or lung parenchyma. Massive haemoptysis is a medical emergency, defined by the volume of blood lost (commonly estimates range from 200–600 ml in 24 hours) or by airway compromise, respiratory distress, or haemodynamic instability.

Common causes vary by age and geography. Infections such as pneumonia, bronchitis, tuberculosis, and bronchiectasis are frequent in many settings. Lung malignancy is a major cause in adults, as are pulmonary embolism with infarction and inflammatory or vasculitic disorders such as granulomatosis with polyangiitis. Other causes include trauma, iatrogenic injury (for example post-bronchoscopy), and the effects of anticoagulant or antiplatelet therapy. Less commonly, fungal infections or non-infectious processes may be involved.

Clinical evaluation focuses on source localisation, severity, and the likely underlying cause. Initial assessment should prioritise airway, breathing, and circulation. Investigations typically include chest radiography, with computed tomography (CT) if needed, sputum analysis, and laboratory tests to assess coagulation and infection. Bronchoscopy is used to locate and potentially treat bleeding and to obtain diagnostic samples, especially when imaging does not identify a source or when bleeding persists.

Management is tailored to the cause and severity. Stabilisation may require airway protection, supplemental oxygen, and transfusion if indicated. Treatment targets the underlying condition (antibiotics for infection, anticoagulation reversal if appropriate, immunosuppression for vasculitis). In refractory or localised bleeding, bronchial artery embolisation or surgical intervention may be considered. Ongoing monitoring and follow-up are essential to manage recurrent or chronic haemoptysis.

Prognosis depends on the cause and severity. Many cases resolve with treatment of the underlying condition, but massive haemoptysis has substantial mortality risk and requires urgent multidisciplinary care.