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Blood in Spit (Hemoptysis)

Blood in Spit (Hemoptysis)

Hemoptysis refers to coughing up blood from the respiratory tract, ranging from blood-streaked mucus to large clots. It may indicate minor irritation or a serious underlying disease. Let’s explore all possible causes:

1. Respiratory Infections (Most Common)

Acute bronchitis – inflammation irritates the airway lining; may cause small blood streaks.
Pneumonia – especially with severe infection, rust-colored or bloody sputum may appear.
Tuberculosis (TB) – classic cause; long-standing cough with blood, weight loss, fever.
Fungal infections like aspergillosis may invade or damage lung vessels and cause bleeding.

2. Chronic Lung Diseases

Bronchiectasis – damaged airways harbor infections and bleed easily.
COPD – chronic inflammation or infection may cause minor hemoptysis.
Cystic Fibrosis – thick mucus and infections can lead to bleeding.
Interstitial Lung Disease (ILD) – in rare cases, due to inflammation or associated autoimmune issues.

3. Vascular Causes

Pulmonary Embolism (PE) – clot in lung blood vessel can lead to sudden chest pain, shortness of breath, and blood-tinged sputum.
Pulmonary hypertension – elevated lung blood pressure may rupture fragile vessels.
Arteriovenous malformations (AVMs) – abnormal blood vessels can burst and bleed.

4. Lung Cancers & Tumors

Non-Small Cell Lung Cancer (NSCLC) or Small Cell Lung Cancer (SCLC) – tumor erodes blood vessels or airway walls.
Bronchial carcinoid tumors – slow-growing, but may bleed easily.

5. Airway Trauma or Iatrogenic Causes

Post-procedure bleeding – after bronchoscopy, biopsy, or intubation.
Violent coughing or foreign body – may cause small vessel rupture and minor bleeding.

6. Autoimmune & Bleeding Disorders

Vasculitis (e.g., Granulomatosis with Polyangiitis) – inflamed blood vessels may bleed into lungs.
Good pasture’s Syndrome – rare disease with bleeding from lungs and kidney involvement.
Systemic Lupus (SLE) – rarely causes alveolar hemorrhage.
Clotting disorders, low platelets, or anticoagulant use can cause or worsen bleeding.

7. Heart-Related Causes

Mitral stenosis (rheumatic heart disease) – elevated pressure in lung vessels causes hemoptysis.
Heart failure – severe left heart failure may rarely lead to pink, frothy sputum (pulmonary edema).

8. Miscellaneous

Nasal bleed (epistaxis) – blood dripping backward may be coughed out (not true hemoptysis).
Drug use (e.g., crack cocaine) – damages airway lining.
Inhalation of toxic gases – may irritate and inflame airway lining.
High-altitude pulmonary edema – rare, but may cause pink, frothy sputum.

Clues from Pattern & Severity

Streaks of blood in sputum: Often from bronchitis, infection, or irritation.
Bright red blood in large quantity: Worrisome — think TB, cancer, or PE.
Blood with fever & cough: Likely infection (TB or pneumonia).
Chronic smoker with hemoptysis: Must rule out cancer.
Hemoptysis with kidney issues: Suggests autoimmune vasculitis.

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