Generality
Blood in phlegm (or hemoftoe ) is a symptom that can depend on numerous conditions. In fact, sputum with blood traces can come from the trachea, bronchi, lungs or any other part of the respiratory system.
The most frequently responsible haemoftoe pathologies are bronchitis, bronchiectasis, chronic obstructive pulmonary disease and infectious airway diseases. However, the blood in the phlegm can also be the consequence of lung cancer, heart disease, vascular lesions and chest trauma.
Once the underlying problem is identified, the hemoftoe can be managed by choosing from the available treatment options. The danger of the symptom derives from the amount of blood found in the phlegm and the duration of the disturbance.
To remember! The haemoftoe manifests itself by the expectoration of blood mixed with phlegm .
What's this
The blood in the phlegm is a symptom of varying degrees, which can range from the appearance in the mucus of simple traces or blood streaks (minimum quantity) to more important manifestations, such as the expectoration of small filaments or clots.
These blood losses, light red or darker, come from the respiratory system, in particular from the lungs, from the trachea or from the bronchi.
The haemoftoe can be occasional or recurrent : in any case, it must never be neglected and must be differentiated from the hemoptysis, that is the emission of conspicuous quantities of bright red blood from the airways, without the presence of mucus.
Causes
The presence of blood in the phlegm may depend on many conditions.
The haemoftoe can derive from the tracheobronchial tree and / or from the pulmonary parenchyma . The most frequently responsible pathologies are bronchiectasis, chronic obstructive pulmonary disease, tumors and infectious diseases .
Respiratory disorders
One of the most common causes of blood in the phlegm is represented by respiratory infections (eg pneumonia and bronchitis) of viral, bacterial, fungal and parasitic origin. In fact, these conditions cause local trauma at the level of the mucosal surfaces of the airways, which is why sputum appears tinged with blood traces. In most cases, when the infection resolves, the symptoms cease.
Chronic bronchitis
Blood in the phlegm is one of the most common symptoms of chronic bronchitis. This inflammation is characterized by a productive cough that has persisted for at least 3 months and can be associated with dyspnea, barrel chest, cyanosis and digital hippocratism.
Recurrent and chronic inflammatory processes can predispose to the development of bronchiectasis, abnormal focal or extended dilation of the respiratory tree, with accumulation of mucus.
This pathological phenomenon is frequently associated with cystic fibrosis . In this context, the blood in the phlegm may be the indicator of damage to the walls of the bronchi: the airways dilate markedly, leading to the potential rupture of an adjacent artery; therefore, in addition to having chronic cough and catarrh, patients who are suffering from it can sometimes expectorate blood.
Possible causes of haemoftoe are also primary (benign and malignant) or metastatic lung tumors (such as renal cell tumors, colon cancer, melanoma and breast cancer).
To remember! The haemoftoe may represent one of the early signs of lung cancer.
The blood in the phlegm may also occur in the event of:
- Chronic obstructive pulmonary disease (COPD);
- Pulmonary edema;
- Embolism with pulmonary infarction;
- Tuberculosis;
- Pulmonary emphysema;
- Inflammation of blood vessels in the lungs (vasculitis).
Expectoration of striated catarrh with blood can also be caused by inhalation of foreign bodies (especially in children), severe trauma or injury to the lungs and rupture of the pulmonary artery.
Other conditions
The blood in the phlegm may also be due to pathological conditions in the neighboring regions, not directly relevant to the respiratory system, including:
- Congestive heart failure;
- Inflammatory lesions of the pharynx;
- Laryngeal tumor;
- Thyroid cancer;
- Various types of infections (bronchial aspergillosis, ebola, etc.);
- Systemic lupus erythematosus;
- Arteriovenous malformations;
- Mitral stenosis;
- Goodpasture syndrome;
- Rib fracture;
- collagen;
- Diseases of blood clotting.
Sometimes the causes of blood in the phlegm are iatrogenic and may include the use of anticoagulant or thrombolytic drugs, cardiac catheterization, airway intubation, surgery, radiotherapy, bronchoscopy and other diagnostic techniques.
Symptoms and Complications
The blood in the phlegm is usually evident through a cough. Depending on the triggering cause, the haemoftoe may present as a sporadic symptom (associated with a single episode) or recurrent (manifest until the underlying pathology is resolved).
How it manifests itself
- Depending on the entity, the haemoftoe can vary from the spit of striated mucus with blood traces to the emission of blood mixed with phlegm.
- Based on the amount of blood expectorated, the catarrh can take on a bright red, pink or brown color, similar to rust. Usually, the more intense the pigmentation of the hemoftoe, the more serious is the problem that lies at the origin of this manifestation.
- In some cases, the blood in the phlegm is frothy, as it is mixed with air.
Possible associated symptoms
When the problem is of a certain gravity, the blood in the phlegm can be associated with other symptoms such as:
- Temperature;
- Breathing difficulties and air hunger (dyspnea);
- Profuse night sweats;
- Increased heart rate (tachycardia);
- Weight loss;
- General malaise;
- Sputum of unpleasant and purulent odor;
- Increased respiratory rate (tachypnea);
- Difficulty breathing in a lying position (orthopnea).
Warning signs to watch out for include:
- Persistent cough, which produces more than a couple of teaspoons of blood mixed with phlegm;
- Chest pain;
- Blood in urine and / or faeces;
- Dizziness.
Diagnosis
The evaluation of blood in the phlegm begins by establishing the true extent of the bleeding. Furthermore, it is necessary to distinguish the haemophysis from blood losses originating from the oral cavity and / or from the digestive tract. For this purpose, an accurate medical history is essential, combined with a careful clinical examination .
For the definition of the cause and the identification of the bleeding site, the fundamental diagnostic test is represented by bronchoscopy . This survey allows the exploration of the trachea and bronchi, and to collect tissue or phlegm samples, to be subsequently subjected to microscopic analysis.
For the etiological classification of the patient, the doctor can subject the patient with hemoftoe to an imaging test : in addition to the standard chest radiograph (RX), important information is provided by pulmonary computed tomography (CT), especially as regards the site and the presence of bronchiectasis.
In the diagnostic procedure, other instrumental investigations can be helpful, including:
- Echocardiography, useful examination in defining pulmonary embolism, left ventricular failure and mitral stenosis;
- Blood count and evaluation of other blood parameters, including PT or PTT determination;
- Microbiological culture and sputum smear to assess the presence of an infectious process.
When to seek medical attention urgently
In the presence of blood in the phlegm, you should always contact your doctor, especially when it is abundant or associated with chest pain, confusion and dizziness.
If the haemophysis occurs as a result of a trauma or a strong contusion to the chest, it is advisable to contact the emergency room as soon as possible.
Differential diagnosis
When evaluating the patient, it is also essential to exclude other sources of bleeding, such as the oropharynx or the gastrointestinal tract.
In particular, the blood in the phlegm is a manifestation that must be distinguished from:
- Nose-pharyngeal bleeding;
- Hematemesis (blood from the digestive system, emitted with vomiting);
- Irritation of the throat associated with violent cough (usually, the amounts of blood emitted with saliva or mucus are minimal).
Treatment
As for treatment, the options vary depending on the cause of the blood in the phlegm.
Possible interventions include:
- Administration of topical vasoconstrictors, such as adrenaline or vasopressin;
- Laser photocoagulation during bronchoscopy;
- Embolization during angiography of the bronchial arteries;
- Selective intubation to inhibit bleeding in the lung where it is occurring.
Surgical solutions are the last resources to counteract the loss of blood in phlegm. These interventions may include a lobectomy or a pneumonectomy.
