Blood-Streaked Phlegm: Causes and Concerns in ENT

Hemoptysis with sputum?

Hello, doctor.
In early April, I noticed blood-tinged mucus when I coughed up phlegm from my nasal cavity.
I later went to a clinic where an endoscopy was performed, and the doctor found slight bleeding, so I was referred to a hospital for further examination.
The doctor at the hospital assessed the situation and felt it was not serious, so they ordered a blood test for nasopharyngeal carcinoma markers and prescribed a nasal spray.
By mid-month, the test results were normal, and I was given an oral medication called Dexamethasone.
However, I still occasionally notice very fine pink streaks of blood in the mucus, and sometimes the color is so faint that it's hard to tell if it's blood.
There have been three instances where the phlegm contained dark red blood clots.
The doctor did ask if I wanted to have a biopsy done.
I am currently considering returning for a biopsy, but how high is the likelihood of nasopharyngeal carcinoma given these symptoms? If it’s not that, what other reasons could cause blood-tinged mucus from the nasal cavity? Thank you!

Rong Er, 40~49 year old female. Ask Date: 2020/04/28

Dr. Ji Zhaoyun reply Otolaryngology

Hello, based on your description, there are many causes of nosebleeds, with the most common being thin nasal mucosa, which can be caused by forceful nose blowing.
However, conditions such as nasopharyngeal or nasal cavity tumors (like nasopharyngeal carcinoma), sinusitis, fungal infections, allergic rhinitis, hypertension, coagulopathy, and nasal trauma can also lead to nosebleeds.
It is advisable to consult an otolaryngologist for examination.
If necessary, a biopsy of any suspicious tissue may be performed.
If oral medication is ineffective, consideration can be given to cauterizing the bleeding nasal vessels using medication or laser treatment.
Wishing you peace and health.
This is purely an exchange of ideas; everything should be based on the physician's actual examination.
Sincerely, Dr.
Chi Chao-Yun, Head of the Department of Otolaryngology, Taichung Hospital, Ministry of Health and Welfare.

Reply Date: 2020/04/28

More Info

Blood-streaked phlegm can be a concerning symptom, especially when it persists or is accompanied by other signs. In your case, it’s understandable to feel anxious about the possibility of serious conditions like nasopharyngeal cancer, especially after experiencing blood in your phlegm. However, it’s important to consider a range of potential causes and to interpret your symptoms in the context of your medical evaluations.

Firstly, the presence of blood in phlegm can arise from various sources within the respiratory tract. Common causes include:
1. Infections: Conditions such as bronchitis, pneumonia, or sinusitis can lead to inflammation and irritation of the airways, resulting in blood-streaked sputum. These infections can cause capillaries in the respiratory tract to rupture, leading to bleeding.

2. Allergies and Irritants: Allergic rhinitis or exposure to irritants (like smoke or pollution) can cause nasal inflammation, which may result in minor bleeding. This could explain the blood-streaked phlegm, especially if you have a history of allergies.

3. Nasal Polyps or Sinus Issues: Nasal polyps or chronic sinusitis can also lead to bleeding. The inflammation associated with these conditions can cause blood vessels to become fragile and bleed.

4. Trauma: Any recent trauma to the nasal area, even minor, can lead to bleeding. This could be from vigorous nose blowing or other forms of irritation.

5. Tumors: While the concern for nasopharyngeal cancer is valid, especially given the symptom of blood in phlegm, it’s important to note that such tumors are relatively rare. The risk factors for nasopharyngeal cancer include certain viral infections (like Epstein-Barr virus), family history, and exposure to certain environmental factors.
Given that your initial tests, including the blood tests for nasopharyngeal cancer markers, returned normal, this is a reassuring sign. However, the persistence of blood-streaked phlegm warrants further investigation. The fact that your doctor has suggested a biopsy indicates they want to rule out any serious conditions definitively.

In terms of next steps, if you are still experiencing symptoms, it would be prudent to follow up with your ENT specialist. A biopsy, while it may seem daunting, can provide clarity and peace of mind. It is a standard procedure that can help diagnose or rule out malignancies.

Additionally, consider discussing the following with your doctor:
- Duration and Frequency of Symptoms: How long have you been experiencing these symptoms? Are they getting worse, or are they stable?
- Associated Symptoms: Are there any other symptoms present, such as weight loss, night sweats, or persistent cough?
- History of Allergies or Respiratory Issues: Any history of allergies or chronic respiratory conditions can provide context to your symptoms.

In conclusion, while blood-streaked phlegm can be alarming, many benign causes exist. The normal cancer markers are a positive sign, but ongoing symptoms should be evaluated further. A biopsy can provide a definitive diagnosis, allowing for appropriate management and treatment. Always communicate openly with your healthcare provider about your concerns and symptoms to ensure comprehensive care.

Similar Q&A

Understanding Blood-Streaked Nasal Discharge: Causes and Concerns

Hello Dr. Zheng, I have been experiencing a runny nose and throat phlegm since early December. In the mornings, I typically have light yellow-green nasal mucus and phlegm, which turns clear by the afternoon. Occasionally, I notice long-accumulated yellow mucus with slight brownis...

Dr. Zheng Jueyi reply Otolaryngology
There are many factors that can cause hemoptysis. Common causes can be categorized into the upper respiratory tract, including the nasal cavity and oral cavity, or the lower respiratory tract, such as the lungs. If an otolaryngologist performs an endoscopy and finds no obvious bl...

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 and Throat Discomfort: ENT Insights

Hello Doctor, I have had tonsil stones for the past two years, but they were small and not frequent, usually coming out on their own when I cough. Recently, for the past two weeks, I have been feeling discomfort on the right side of my tonsil, and I noticed a foul smell when I br...

Dr. Zheng Jueyi reply Otolaryngology
Hello, generally, a wound should fully improve within about a week. As for the discomfort, it may be related to chronic tonsillitis or stones. It is recommended to drink plenty of water, gargle, and maintain a regular routine. Thank you for your message. Wishing you peace and goo...

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.