Common Conditions

Coughing out blood (Haemoptysis)

What is haemoptysis?

Haemoptysis is a symptom. This happens when a person coughs out blood. This has to be differentiated from blood that is vomited or which comes from the nose. It refers specifically to the symptom of blood coming from the lower airways. It can be in varying amounts ranging from blood staining the sputum to coughing out fresh blood in large amounts. In all cases when you have this symptom, a doctor should be consulted as soon as possible.

Do I have to go to the hospital immediately if I have haemoptysis?

The urgency to seek medical treatment depends on the amount of blood coughed out as well as any associated symptoms. In general, if the amount of blood is small, i.e. only streaking the sputum or a small piece the size of a coin and it only occurs once or twice, you can wait for the next day to seek a medical opinion. In the event that the amount is larger or it does not stop, immediate medical attention must be sought either at your family doctor, a chest specialist or at the Accidents and Emergency department of a nearby hospital.

If you have symptoms, especially if short of breath , giddy or if you feel unwell, seek medical attention immediately even if the amount of blood is small.

Are all causes of haemoptysis dangerous?

Coughing out of blood can be associated with mild conditions such as a sore throat or sinusitis. Treatment of the underlying condition will usually cause the bleeding to stop. On the other hand, tuberculosis and lung cancer both often present with haemoptysis.

What are the causes of haemoptysis?

Haemoptysis is a symptom that can occur with many underlying conditions such as these below:

  • Sinusitis
  • Pharyngitis
  • Tuberculosis
  • Lung cancer
  • Bronchiectasis
  • Lung abscess
  • Pneumonia
  • Heart conditions like heart failure, mitral stenosis
  • Pulmonary embolism
  • Pulmonary haemorrhage syndromes. These are rare causes
  • Alveolar haemorrhage . Usually associated with systemic conditions such as connective tissue disease
  • Bleeding disorders such as low platelet count
  • Trauma
  • Foreign body in the airway

If I only cough out a small amount of blood once, should I still bother to see the doctor?

All patients with haemoptysis should be reviewed by a doctor. If the haemoptysis never recurs, it is likely to be a trivial cause. However, if there are other symptoms like weight loss, fevers or if you are a smoker, you must seek medical opinion even if there appear to be no more episodes of haemoptysis.

How is haemoptysis investigated?

If the amount of blood expectorated is large, you will likely be admitted to hospital and the necessary investigations will be performed there. If the amount of blood is small, you may be investigated as an outpatient. A chest x-ray will usually be performed. You may then be sent for an assessment by the Ear, nose and throat surgeon if this has not been done. This usually involves inspecting the nasal passages with an instrument called an endoscope and is done in the doctor’s office. Further investigations may include sputum examination for TB, a CT scan of the lungs and possible inspection of the airways by bronchoscopy.

What is bronchoscopy?

Bronchoscopy is the examination of the airways that allows the doctor to inspect the trachea and bronchi ( main airway passages) with a fibre optic instrument called a bronchoscope. The procedure usually is done as a day procedure under local anaesthesia and sedation. The patient is aware but drowsy. You will need to fast for at least 4 hours before the procedure which is usually done in the endoscopy centres in the hospital. you are usually discharged on the same day.


[Article Ref: Singapore Respiratory Specialists (SRS)]