HAEMOPTYSIS

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Haemoptysis is the coughing of blood originating from the respiratory tract below the level of the larynx. Haemoptysis should be differentiated from:

  • Haematemesis – vomiting of blood from the gastrointestinal (GI) tract.
  • Pseudohaemoptysis – where a cough reflex is stimulated by blood not derived from the lungs or bronchial tubes. This may be from the oral cavity or nasopharynx (eg, following an epistaxis) or following aspiration of haematemesis into the lungs.
Haemoptysis

What causes haemoptysis?

One of the most common causes of haemoptysis is an infection such as bronchitis or pneumonia. If this is the case, you might also have a cough and fever.

Another common cause is bronchiectasis , a disease where the large airways in the lungs are damaged. In this case, you might have recurrent chest infections and a productive cough.

Other causes of haemoptysis include:

  • chronic obstructive pulmonary disease (COPD)
  • Lung cancer
  • Tuberculosis
  • Pulmonary embolism or a blood clot in the arteries that supply blood to the lungs
  • a lung abscess
  • lung injury
  • having something stuck in the airway
  • using drugs
  • having fluid in the lungs due to a heart condition
  • being on anticoagulant therapy (blood-thinning medications)
  • having cystic fibrosis

Common Causes:-


• Pulmonary tuberculosis.
• Mitral stenosis.
• Lung diseases, i.e. bronchiectasis, acute pneumonia,
infarct, fibrosis.
• Ulceration of larynx or trachea.

Sometimes, doctors cannot find the cause.

Hemoptysis Diagnosis and Tests

If you’re coughing up blood, your doctor will do one or more of these:

  • Medical history and physical exam . This helps them gather clues to identify the cause.
  • Chest X-ray. This can show whether there’s a mass in your chest or areas of fluid or congestion in your lungs.
  • CT scan . With detailed images of the inside of your chest, this test may reveal some causes for coughing up blood.
  • Bronchoscopy . Your doctor runs a flexible tube with a camera on its end, called a bronchoscope, through your nose or mouth and into your windpipe and airways.
  • Complete blood count (CBC). This test checks the number of white and red blood cells in your blood, along with platelets (cells that help blood clot).
  • Urinalysis . Some causes of hemoptysis also show up on this simple urine test.
  • Blood chemistry profile. This test measures electrolytesand how well your kidneys are working.
  • Coagulation tests. Changes to your blood’s ability to clot, or coagulate, can lead to bleeding and coughing up blood.
  • Arterial blood gas. This test measures the levels of oxygen and carbon dioxide in your blood. Oxygen levels can be low in people coughing up blood.
  • Pulse oximetry. A probe (usually on a finger) tests the level of oxygen in your blood.

Treatment:-

Treatment for hemoptysis depends on how much blood you’re coughing up and what’s causing it.

Life-threatening or massive hemoptysis

Your doctor will move you into the hospital’s intensive care unit (ICU). They may have you see a pulmonologist and a cardiothoracic surgeon, doctors who specialize in the chest and respiratory tract.

Your first treatment could include:

  • A tube that goes into your airways (intubation)
  • Extra oxygen (ventilation)
  • A body position in which the lung with possible bleeding is lower than the other lung

When your doctor finds the source of the bleeding, they might try to stop it with:

  • Iced saline
  • Medications to narrow blood vessels (vasoconstrictors) like epinephrine or vasopressin
  • Medicines to help blood clot (coagulants) like tranexamic acid
  • Tiny balloons or cuffs to put pressure on the area (bronchial blockade or balloon tamponade)
  • Laser therapy
  • Argon plasma coagulation (APC)
  • Cryotherapy
  • Embolization

In rare cases, you may need surgery. This could involve:

  • Taking out one section (lobe) of your lung
  • Removing the entire lung

When you’re out of danger, your doctor will treat what’s making you cough up blood. You might get:

-Inj Calmpose or Valium 10 mg IM. If small haemo- ptysis. Tab Calmpose 1 stat.
-In severe cases inj 100 mg Pethidine.
-Bed rest in semi-reclining position and leaning on the elbow on affected side to minimise aspiration of blood.
-Blood transfusion if profuse bleeding.
-Antitussive if cough is exhaustive or troublesome. Small doses of Codein or other cough suppressive may be given.
-Antibiotics are of preventive use to avoid
secondary infection.
Note—Haemostatic agents are of no value in control of haemoptysis.

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