About this symptom
Coughing up blood, called haemoptysis, means spitting up blood or bloody phlegm that comes from the lungs and airways. The blood is often bright red or rust-coloured and looks frothy, because it is mixed with air and mucus. Sometimes it shows only as streaks in the phlegm.
Bleeding from the mouth, throat or gut is different, so tell the doctor what you saw. Coughing up blood has many possible causes and could be something serious, so it is important to get it checked. Most people do well with treatment for both the bleeding and its cause, though heavy bleeding is dangerous.
Possible causes
This is not a diagnosis. These are the causes doctors think about, with the ones that are most urgent to rule out first.
- Pulmonary embolismA blood clot in the lung. Trouble breathing that comes on suddenly, a very fast heartbeat, and pain in the chest or upper back.Read about it
- TuberculosisA cough lasting two weeks or more with blood in the phlegm, fever in the evening, night sweats, weight loss and tiredness.Read about it
- PneumoniaBlood-stained phlegm with a cough, a high temperature, breathlessness, and chest pain that is worse when you breathe in or cough.Read about it
- Lung cancerA cough that does not go away, with coughing up blood, breathlessness, chest pain, weight loss, or chest infections that keep coming back.
- BronchiectasisWidened airways that make a lot of mucus: a long-lasting cough with plenty of phlegm, frequent chest infections and sometimes streaks of blood.Read about it
- BronchitisStreaks of blood in phlegm during a bad chesty cough, usually after a cold or flu. It normally clears in about three weeks.Read about it
- A hard or long-lasting coughAn irritated throat or airway from violent coughing can bring up small amounts of blood. It still needs checking.
- Blood-thinning medicinesMedicines that thin the blood can cause bleeding if taken above the recommended amount. Do not change or stop them yourself: tell the doctor.
When to get help
Also get emergency care for:
- Coughing up blood together with blood in the urine or stools
- Someone who has collapsed or is not breathing normally: call for help and start CPR if you know how
See a doctor as soon as possible, the same day if you can, if you have:
- A few small spots, flecks or streaks of blood in the phlegm or on a tissue, even once
- Blood in the phlegm with fever, night sweats or weight loss
- A cough that has lasted more than two to three weeks
- Any blood in the phlegm while taking medicines that thin the blood
Do not wait to see whether it happens again. In India, blood in the phlegm, or a cough of two weeks or more, is a reason to be tested for tuberculosis (TB). TB can be cured, and treatment is free at government health facilities.
What you can do at home
With any emergency sign, do not stay at home: call for an ambulance first and follow any advice the operator gives. For small amounts of blood, home steps only help the doctor.
Do
- Note when it began, how often it happens, and how much blood there is: spots, streaks or more
- Tell the doctor about every medicine you take, especially blood thinners, and any other symptoms
- Take your medicines with you to the appointment or to hospital
Do not
- Do not drive yourself to hospital
- Do not take cough medicines to stop the cough without asking a doctor first, as they can block the airways
- Do not change or stop a prescribed medicine on your own: ask the doctor
What the doctor will do
The doctor will ask how much blood you cough up, whether it is streaks in phlegm or larger amounts, how often it happens and for how long, and whether it is worse at certain times, such as at night. They will ask about fever, weight loss, night sweats, smoking, contact with TB, and medicines that thin the blood, and examine your chest and lungs.
Tests depend on the likely cause. They may include:
- A chest X-ray, and often a of the chest
- A phlegm sample, tested for infection including TB
- A complete blood count and blood clotting tests
- Bronchoscopy, a thin tube with a camera passed into the airways to see where the blood is coming from
Treatment aims to stop the bleeding and treat the cause, such as for an infection or a course of TB treatment. In an emergency, treatment to control the bleeding is given in hospital.
Myths and facts
Things people often say about this. Open each one to see what is true.
Myth“A little blood in the phlegm is normal, or just from the throat.”What is true?
Fact
A hard cough can irritate the throat and bring up a small amount of blood, but a doctor should check any blood in the phlegm, even if it happens only once. Causes such as TB, a blood clot in the lung and other lung problems need to be found.
Myth“Coughing up blood always means TB or cancer, and nothing can be done.”What is true?
Fact
Blood in the phlegm has many causes, including chest infections, bronchiectasis and blood clots as well as TB and lung cancer. Most people do well with treatment for the cause. TB can be cured, and in India treatment is free at government health facilities.
Myth“I can wait a few days to see if it stops.”What is true?
Fact
Even if the bleeding stops, the cause is still there. Get it checked as soon as possible. If you cough up more than a few streaks, or have trouble breathing or chest pain, call for an ambulance.
Questions to ask your doctor
Tick the ones you want answered and take them with you.
Common questions
Is it serious if there is only a little blood in my phlegm?
It could be something serious, so it is important to get it checked as soon as possible, even if the amount is small or it happens only once. A few spots or streaks mean see a doctor soon. More than that, or any blood with trouble breathing or chest pain, means call for an ambulance.
Does coughing up blood mean I have TB?
Not always. TB is one possible cause, along with chest infections, bronchiectasis, a blood clot in the lung and lung cancer. TB is looked for with a chest X-ray and a phlegm test. If it is TB, it can be cured, and treatment is free at government health facilities.
How can I tell blood from the lungs from blood from the stomach?
Blood from the lungs is often bright red or rust-coloured and frothy, because it is mixed with air and mucus. Bleeding from the mouth, throat or gut is different. You may not be able to tell, so describe to the doctor what you saw.
What should I do while waiting for the ambulance?
Sit down, rest and have someone stay with you. Note when it began and how much blood there is, and keep your medicines with you. Follow any advice the operator gives. Do not drive yourself, and do not take cough medicines to stop the cough.