Should I Go to the ER for Coughing Up Blood?

Causes of coughing up blood include:

• Respiratory tract infection (most common cause)
• Chronic obstructive pulmonary disease (COPD)
• Smoking
• Inhaled (aspirated) foreign object that (usually seen in children)
• Cystic fibrosis
• Certain types of cancer
  • Lung cancer
  • Esophageal cancer
• Fungal infection with Aspergillus (aspergillosis)
• Tuberculosis
• Pulmonary edema
• Wegener's granulomatosis
• Inflammation of blood vessels (vasculitis) in the lung
  • Goodpasture syndrome 
  • Granulomatosis with polyangiitis
• Certain drugs or chemicals
  • Cocaine 
  • Bevacizumab  
  • Nitrogen dioxide exposure in indoor ice arenas 
  • E-cigarette or vaping product use associated lung injury (EVALI)  
• Certain medical procedures
  • Tonsillectomy
  • Bronchoscopy
  • Laryngoscopy
  • Spirometry
  • Upper airway biopsy

Uncommon causes of coughing up blood that can be serious or life-threatening include:

• Acute bronchitis 
• Other lung infections such as bacterial lung abscess and/or necrotizing pneumonia
• Immunologic lung diseases, such as anti-glomerular basement membrane (anti-GBM; Goodpasture) disease, granulomatosis with polyangiitis, systemic lupus erythematosus (SLE), idiopathic pulmonary hemosiderosis, primary antiphospholipid antibody syndrome, Behçet syndrome, and microscopic polyangiitis
• Penetrating, rather than blunt, trauma 
• Pulmonary vascular diseases 
  • Pulmonary arteriovenous malformations (PAVMs)
  • Mitral stenosis 
  • Blood clot in the lung (pulmonary embolism)
  • Congenital heart disease or severe pulmonary hypertension 
• Chemotherapy and bone marrow transplantation
• Acquired and iatrogenic trauma
• Posterior arterial nosebleeds
• Heart failure and heart valve disorders 
• Right heart catheterization (i.e., pulmonary artery catheterization) 
• Fistulas, such as fistulas between the aorta and the airway 
• Medical interventions, including percutaneous or transbronchial lung biopsy, cryobiopsy, central vein venipuncture during pacemaker insertion, and ablative procedures for endobronchial masses

In addition to a patient history and physical examination, the cause of coughing up blood is diagnosed with tests such as: 

• Chest X-ray
• Chest computerized tomography (CT) scan
• Blood tests
  • Complete blood count (CBC)
  • Blood chemistry
  • Arterial blood gas
• Urinalysis
• Coagulation studies such as prothrombin time (PT) or partial thromboplastin time (PTT)
• Bronchoscopy
• Lung biopsy
• Lung scan
• Pulmonary arteriography
• Sputum culture and smear
• Pulse oximetry

In mild cases, coughing up blood may go away on its own or when the underlying cause is treated. 

Smokers should stop smoking. Other treatments for coughing up blood may include:

• Antibiotics for pneumonia, tuberculosis, or other bacterial infections
• Chemotherapy or radiation for lung cancer
• Steroids for inflammatory conditions

Treatment for serious cases of coughing up large amounts of blood may require hospitalization which may include a stay in the hospital’s intensive care unit (ICU).