Hemoptysis- What it is, Causes & Treatment

Hemoptysis is the coughing /spitting up of blood from the respiratory tract. It's unremarkably caused by pneumonia, bronchiectasis, bronchitis, and carcinoma. The expectorated blood sometimes originates from the vessels. Once hemoptysis is observed then it should be classified based on severity, and the origin and reason behind the hemoptysis is determined. Lateral and AP chest X-ray is the initial study, though a standard chest X-ray doesn't rule out the chance of malignancy or any underlying pathology.

Multidetector CT (MDCT) should be performed in patients with frank hemoptysis, suspicion of bronchiectasis or associated risk factors for carcinoma, and in those with signs of pathology on chest X-ray.

MDCT  may be a non-invasive imaging technique that will pinpoint the presence, origin, variety, and source of the general (bronchial and non-bronchial) and pneumonic blood vessel sources of bleeding. Endovascular embolization is the safest and simplest methodology for managing bleeding in severe hemoptysis.

Flexible bronchoscopy plays a crucial role in the diagnosing of hemoptysis in patients with frank hemoptysis. The procedure is performed in the intensive care unit; it is used for immediate management of bleeding and is additionally effective in locating the source of the hemorrhage.

Causes of hemoptysis -

There is a broad medical diagnosis for hemoptysis, associated with infections, tracheal involvement, malignancy, and foreign body aspiration or trauma. In developing countries, one of the foremost common causes of hemoptysis is TB. However, in developed countries, bacterial infection superimposed on chronic respiratory sickness, like Cystic Fibrosis is also the cause. Acute infectious respiratory disease, pneumonia; and other infectious agents, like Aspergillus, Nocardia, and non-tuberculosis mycobacteria, may additionally be accountable.

Finally, bleeding disorders, medicine use, foreign body aspiration, and respiratory organ trauma can contribute to the etiology of hemoptysis.

Treatment for hemoptysis –

Treatment of hemoptysis depends on the underlying cause and severity. In large hemoptysis or severe hemoptysis, securing the patient’s airway is a priority. Start on Basic medical aid, intubated, or repositioned in the lateral attitude position (i.e., on the affected side), which uses gravity to stop blood from getting into the unaffected lung. Intravenous fluid and transfusion are also indicated. Bronchoscopy to insert a balloon tube or embolize the artery to prevent further bleeding can be used. In some circumstances, surgical intervention is also needed.

In non-massive hemoptysis, management of the underlying cause is the first treatment strategy. Infection is treated with antibiotics, antivirals, or antifungals. Signs of malignancy might need a consultation with an oncologist. Underlying chronic respiratory sickness is also treated with glucocorticoids, bronchodilators, mucolytics, chest physiotherapy, or basic first aid. Studies have additionally shown that inhalation of tranexamic acid (i.e., antifibrinolytic) in people with mild hemoptysis provides fast symptomatic relief and shorter hospital stays.