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45-year-old Samu had just one vice he smoked a pack of cigarettes since he was 22 years old. All was well till he developed a nagging cough and sputum production. And then he started losing weight, a whopping 15 kg in three months. Gradually he developed a fever which rose over the month. The cough worsened and he noticed streaks of blood in the sputum. And then one day he coughed up almost a cup of bright red blood. He decided to consult a doctor. Why was he coughing up blood?
Coughing up blood, that is, blood in the phlegm, can be a scary experience. Medically it is called haemoptysis and is defined as spitting up of blood or bloody mucus from the lungs and throat. Samu was diagnosed with pulmonary tuberculosis but there are many reasons why you could cough up blood.
Infection
Infections are the most common causes of coughing up blood. They account for 60 to 70 percent cases of all haemoptysis. Infections may be caused by invasive bacteria such as Staphylococcus aureus and Pseudomonas aeruginosa or fungi such as Aspergillus species.
Viruses such as influenza may cause severe hemoptysis. Human immunodeficiency virus (HIV) infection lead to several conditions that may produce hemoptysis.
Bronchitis and pneumonia
When the air passages (bronchi) are inflamed because of virus infection it is called bronchitis. The symptoms include
- Low grade fever
- Shortness of breath that worsens with activity
- Cough that produces mucus, sometimes bringing up blood with the mucus
- Wheezing
- Fatigue and chest pain
Pneumonia is the infection in the lungs caused mostly by bacteria Streptococcus pneumonia, but it could be caused by other bacteria, virus, or fungi. It has similar symptoms to that of bronchitis but in a much larger scale, for example, high grade fever with chills, shortness of breath even without activity, and you are likely to feel sicker.
Type of haemoptysis: Mild.
Bronchiectasis
Bronchiectasis occurs in cases of recurrent inflammation of the lungs. The airways become very enlarged and excess mucus builds up in the airways.
Symptoms include
- Bluish tinge to the skin
- Foul breath odour
- Coughing up mucus with streaks of blood and worsening of cough when lying on one side
- Shortness of breath that worsens with activity
- Fatigue, wheezing, paleness
Type of haemoptysis: Streaks of blood in the mucus.
Cystic fibrosis is a form of bronchiectasis that is congenital (present at birth).
Cystic fibrosis complication
Cystic fibrosis is a life threatening disease caused by a defective gene. Thick mucus builds up in the lungs and pancreas resulting in life threatening lung infections and problems of digestion. This condition can usually be diagnosed by the age of 2 years. Those with milder forms of disease are diagnosed only when they become young adults. People with cystic fibrosis rarely live past their 30s. But early diagnosis of the disease can improve survival and quality of life. Death is usually caused by lung complications.
Symptoms: Coughing up blood occurs as a complication of cystic fibrosis. Symptoms in new born include delayed growth, no bowel movement in the first 24 to 48 hours of life, salty tasting skin. Symptoms related to lung infection include
- Increased coughing and fatigue
- Nasal congestion caused by nasal polyps
- Recurrent episodes of pneumonia
Type of haemoptysis: Massive.
Tuberculosis
Pulmonary tuberculosis is the leading cause of haemoptysis in India, say doctors from ChatrapatiSahujiMaharaj Medical University, Lucknow.But this frightening symptom of coughing up blood does not always mean that you have lung tuberculosis, they add.
Long standing tobacco abuse is one of the main causes of pulmonary tuberculosis.
Symptoms: Cough is the main symptom of TB. Others include
- Coughing up blood usually with mucus
- Night sweats
- Fever and fatigue
- Breathing difficulty and chest pain
- Weight loss
Type of haemoptysis: Blood tinged sputum. Massive haemoptysis in the later stages.
Cancer
Lung cancer is a major cause of haemoptysis. The cancer originates in the lining of the main airways. Although it is a less common cause of haemoptysis as compared with bronchitis or bronchiectasis, about 20 percent of those affected with lung cancer may have haemoptysis at some point. The bleeding may occur because of
- Tumour cell death
- Rupture of small blood vessels in the area of tumour
- When the tumour erodes a large pulmonary blood vessel causing massive bleeding.
Symptoms: Symptoms of lung cancer include
- Coughing up blood
- Wheezing, shortness of breath
- Poor appetite, fatigue and unexplained weight loss
- Chest pain when tumour spreads to surrounding area
- Clubbing of fingers in some cases
Type of haemoptysis: Coughing up red or rust coloured phlegm.
Pulmonary venous hypertension
Heart conditions such as ventricular systolic heart failure, mitral stenosis, or a blood clot in the pulmonary artery (pulmonary embolism) can cause one to cough up blood. These are however rare causes of haemoptysis, though haemoptysis is the recognized symptom of pulmonary embolism.
Symptoms of pulmonary embolism:
- Sharp stabbing chest pain
- Shortness of breath
- Coughing that is usually dry but sometimes with blood or with mucus containing blood
Pulmonary oedema
Pulmonary oedema is the abnormal buildup of fluid in the air sacs of the lungs because of disorders such as congestive heart failure, kidney failure, major injury, lung damaged by infection or poisonous gas, and even high altitudes.
Symptoms:
- Coughing up blood
- Difficulty breathing when lying down
- Gurgling or wheezing sounds with breathing
- Anxiety and excessive sweating
- Swelling in the legs
- Decreased alertness
Type of haemoptysis: Pink and frothy sputum.
Pulmonary veno-occlusive disease
This is a rare disease occurring in children and young adults characterized by high blood pressure in the lung arteries connected to the right side of the heart. Although the cause is not exactly known, viral infection or complications of chemotherapy, bone marrow transplantation, and blood cancer is thought to be responsible for this disorder.
Symptoms: Apart from coughing up blood, other symptoms include
- Shortness of breath
- Difficulty breathing while lying flat
- Fatigue
Severe acute mountain sickness
Also known as altitude sickness or high altitude pulmonary edema, this illness affects mountain climbers especially those who climb fast, and those travelling at high altitudes, say, at 8000 feet. Acute mountain sickness is caused by reduced air pressure and lower oxygen levels at high altitudes.
Symptoms: Shortness of breath with exertion, dizziness, fast heart rate, headache, nausea and loss of appetite are symptoms of mild acute mountain sickness. For severe form of the illness, the symptoms include
- Cyanosis (blue colored skin)
- Coughing up blood
- Shortness of breath even at rest
- Confusion
- Chest tightness
- Decreased consciousness
Systemic lupus erythematosus
Lupus or SLE is an autoimmune disease where the body's immune system attacks healthy tissues of any organ including the lungs. This disease is more common in women than in men, especially African-Americans and Asians.
Symptoms: Coughing up blood and difficulty breathing are the symptoms when SLE affects the lungs. In general, joint pain and swelling is common to everyone with SLE. Other symptoms include
- Swollen lymph nodes
- Chest pain, fatigue, malaise, and fever with no other cause
- Sensitivity to sunlight; skin rash mainly on cheeks or bridge of the nose
- Hair loss
Complication of lung SLE can result in blood clots in the lungs, development of fluid around the lungs, and damage to the lung tissue.
The amount of blood coughed up is an important way to diagnose the cause. For example, bronchitis and pneumonia that make up most cases of haemoptysis do not have severe bleeding, but lung cancer, chemotherapy, cystic fibrosis and tuberculosis may show massive haemoptysis and have a high mortality risk.
This section is brought to you by Benadryl cough syrup
Reference:
Pulmonary veno-occlusive disease - https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001139/
Cystic fibrosis - https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001167/
Mountain sickness - https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001190/
SLE - https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001471/
TB - http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2700474/#__ffn_sectitle
Pulmonary oedema - https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001195/
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