Blood-Streaked Phlegm: Allergies or Something More?

Hemoptysis (coughing up blood)

Hello, Doctor.
I have a history of allergic rhinitis, but in the past few weeks, I have noticed some unusual symptoms.
About a month ago, I started to intermittently smell a metallic or bloody odor, and I have been coughing up phlegm that occasionally contains a small amount of blood, although I do not have a cough.
My nasal discharge is minimal, and I do not sneeze frequently, so it shouldn't be due to blowing my nose too hard.
When I do have nasal discharge, it appears normal; only the postnasal drip seems to have blood.
This has been ongoing for a month now, but it does not occur every day—approximately every one to two days, I experience blood-tinged phlegm.
Concerned about the possibility of nasopharyngeal cancer, I visited a clinic where the doctor examined my nasopharynx with a nasopharyngoscope and said it looked normal.
I would like to ask if this is related to my nasal allergies.
Is it normal for this situation to persist for over a month?

Allen, 20~29 year old female. Ask Date: 2016/05/29

Dr. Ji Zhaoyun reply Otolaryngology

Hello, if you continue to have blood in your sputum for more than a month after treatment, it is advisable to consider a "nasopharyngoscopy" examination in the otolaryngology department.
This procedure allows for a clear view of the nasopharynx and other conditions in the nasal area, helping to rule out nasopharyngeal tumors and other nasal lesions (such as fungal infections, sinusitis, etc.).
The presence of blood in the sputum may originate from three areas: 1) The nose: Due to allergies, the nasal mucosa can become fragile, and blood vessels may rupture when blowing the nose forcefully, rubbing the nose, picking the nose, or coming into contact with allergens, leading to bleeding.
This situation can be improved with appropriate hemostatic measures and control of nasal allergies.
2) The bronchi and thoracic cavity.
3) Gastrointestinal bleeding.
Based on your description, the likelihood of the second and third sources seems lower.
It may be worth considering further examination if symptoms persist after nasal treatment.
Wishing you peace and health.
Sincerely, Dr.
Chi Chao-Yun, Head of the Otolaryngology Department, Taichung Hospital, Ministry of Health and Welfare.

Reply Date: 2016/05/29

More Info

Blood-streaked phlegm can be concerning, especially when it persists over a period of time. In your case, given your history of allergic rhinitis and the recent onset of blood-streaked phlegm, it is essential to consider various potential causes and their implications.

Firstly, allergic rhinitis can lead to inflammation of the nasal passages, which may cause irritation and minor bleeding, particularly if you are experiencing nasal congestion or if you are inadvertently irritating your nasal passages by frequent nose blowing or sniffing. However, the presence of blood in your phlegm, especially if it is not accompanied by significant coughing or other respiratory symptoms, raises the need for further evaluation.

The fact that you have been experiencing a blood-tinged phlegm intermittently for about a month is noteworthy. While it is possible that this could be related to your allergies, it is crucial to rule out other potential causes. For instance, conditions such as sinusitis, bronchitis, or even more serious issues like pulmonary embolism or malignancies can present with similar symptoms. Although your doctor has examined your nasal passages and found them to be normal, it may be beneficial to consider additional diagnostic tests, such as a chest X-ray or a CT scan, especially if the symptoms persist or worsen.

Moreover, the intermittent nature of your symptoms is also important. If the blood-streaked phlegm occurs sporadically and is not associated with other alarming symptoms such as significant weight loss, night sweats, or persistent cough, it may be less likely to indicate a serious condition. However, the fact that you are experiencing a blood-like taste or smell could suggest that the source of the bleeding might be from the upper respiratory tract, possibly from the sinuses or nasal passages.

In terms of management, if your symptoms are indeed related to allergies, you may benefit from optimizing your allergy management plan. This could include the use of antihistamines, nasal corticosteroids, or other allergy medications that can help reduce inflammation and irritation in your nasal passages. Additionally, staying hydrated and using saline nasal sprays can help keep your nasal passages moist and may reduce the likelihood of bleeding.

It is also essential to monitor your symptoms closely. If you notice any changes, such as an increase in the frequency or volume of blood in your phlegm, or if you develop new symptoms such as fever, significant cough, or difficulty breathing, you should seek medical attention promptly.

In conclusion, while your symptoms may be related to your existing allergic rhinitis, the persistence of blood-streaked phlegm warrants further investigation to rule out other potential causes. It is advisable to follow up with your healthcare provider for a comprehensive evaluation and to discuss the possibility of additional diagnostic testing. Your health and peace of mind are paramount, and addressing these symptoms proactively is the best approach.

Similar Q&A

Understanding Blood-Streaked Phlegm: When to Seek ENT Care

Hello doctor, I have been suffering from allergic rhinitis. About a month ago, while I was lying in bed trying to sleep, I suddenly coughed up fresh blood. For the following week, I would cough up one or two mouthfuls of fresh blood whenever I lay down (this lasted about 1 to 3 m...

Dr. Zheng Jueyi reply Otolaryngology
Hello: If there is no improvement, it is recommended to return to the ENT and Pulmonary Medicine departments for continued follow-up and examination. Wishing you safety and health. Sincerely, Dr. Cheng Jue-Yi, Director of the ENT Department, Taoyuan Hospital, Ministry of Health a...

Understanding Blood-Streaked Phlegm: When to Seek Medical Attention

At the end of May, I had a cold and coughed up green phlegm with blood streaks. I saw a doctor and took medication, which helped, but afterwards, the phlegm continued to have blood streaks. I went to the hospital to see a pulmonologist, and both X-rays and CT scans were normal, b...

Dr. Li Jiaxuan reply Otolaryngology
Bleeding can occur from the nasal cavity to the tracheal mucosa, and bronchoscopy should be considered. Wishing you safety and well-being.

Understanding Blood-Streaked Phlegm: When to Seek Further ENT Evaluation

Hello Doctor, my condition started in mid-December when I noticed blood-streaked mucus in my first morning phlegm. I visited a clinic where the doctor initially prescribed antibiotics and allergy medications for my nose. After finishing the medication, my morning phlegm remained ...

Dr. Zheng Jueyi reply Otolaryngology
Hello: You can discuss your symptoms in detail with a physician at National Taiwan University. Whether special examinations are necessary will still be determined by the clinical physician. Wishing you peace and good health. Sincerely, Dr. Cheng Jue-Yi, Director of the Department...

Understanding Blood-Streaked Phlegm: Causes and Concerns

Hello doctor, while I was showering, I sneezed and blew my nose, and I noticed a bit of blood mixed with mucus. Later, I felt some phlegm in my throat with blood streaks, but now it's gone. I'm wondering if this is related to the connection between the nose and throat. ...

Dr. Hong Yuanbin reply Internal Medicine
Hello, more severe pneumonia can indeed cause coughing up blood; however, the blood that is coughed up is typically rust-colored and in large amounts. As for the blood you described, it is likely to be bright red streaks, which can occur due to the rupture of small blood vessels ...