Blood in Saliva: Causes and When to Seek Help

Blood in saliva?

Hello Doctor, I visited an otolaryngologist yesterday because I felt a bit under the weather.
The doctor prescribed me some medication, and I just took a purple and yellow capsule labeled clindamycin, which I heard could cause esophagitis.
I made sure to drink more water, but I still felt a sudden tightness in my throat and chest after taking it.
I continued to drink water, which alleviated some discomfort.
However, I also ate a packet of red yeast rice cookies, and when I rolled my tongue to spit it out, I noticed blood mixed in.
At first, I thought it was just the red yeast, but upon closer inspection, it looked like blood, somewhat reminiscent of when I had a nosebleed that mixed with phlegm or saliva but didn’t completely disperse.
I saw blood a couple of times when I followed it with food, and the food was only in the throat area since I didn’t induce vomiting or cough forcefully.

I would like to ask the doctor what might be causing this.
Later, the phlegm or saliva seemed to decrease significantly, turning transparent within a minute.
It feels like the saliva and phlegm might be connected to my nose when I pull my tongue, but I’m not sure if that’s just my imagination.
I’m worried that I might have some underlying condition, as I’ve heard that lung issues or tumors can cause coughing up blood.
I’m not clear if this counts as coughing up blood.
However, when I saw the doctor yesterday, he listened to my lungs and said there were no issues.
Now I’m suddenly very anxious about this, but I’m unsure if I need to go to the emergency room.
Currently, I have no symptoms, and the food has passed.
I’m afraid of going to the ER without knowing what to do.
Should I just wait until my follow-up appointment on Monday to discuss this with my doctor? I apologize for bothering you on your day off, thank you.

Mia, 20~29 year old female. Ask Date: 2021/08/21

Dr. Hong Yuanbin reply Internal Medicine

Hello, based on your description, it seems you might be seeing saliva mixed with bright red blood? Typically, if the bleeding is from the lungs or a tumor, the blood would appear darker, more reddish-brown.
The color you described is more likely due to gum bleeding, which can occur when the gums are more fragile during a cold or illness.
Brushing your teeth vigorously or using your tongue to push against the gums can occasionally cause bleeding.
This should resolve once your body recovers.
I recommend drinking plenty of water and getting ample rest.
If you do not see any further bleeding, it should be fine.
However, if the bleeding persists, you should seek medical attention.
Thank you for your question.

Reply Date: 2021/08/21

More Info

When it comes to the presence of blood in saliva, there are several potential causes, and understanding these can help determine when to seek medical attention. In your case, the recent use of clindamycin, a common antibiotic, raises some concerns, especially since it can cause esophagitis if not taken properly. This could lead to irritation in the throat or esophagus, which might explain the discomfort you felt in your throat and chest.

The appearance of blood mixed with saliva or mucus can be alarming, and it’s essential to consider various factors. Blood in saliva can originate from several sources, including:
1. Oral Cavity: Issues such as gum disease, oral infections, or trauma to the mouth can lead to bleeding. If you have been experiencing any gum issues or have had recent dental work, this could be a contributing factor.

2. Throat or Esophagus: As mentioned, irritation from medications like clindamycin can cause inflammation in the throat or esophagus, potentially leading to minor bleeding. If you have been coughing or clearing your throat frequently, this could also cause small blood vessels to rupture.

3. Respiratory Tract: Conditions affecting the lungs or bronchi, such as infections or even more serious issues like tumors, can lead to coughing up blood. However, since your doctor listened to your lungs and found no issues, this possibility seems less likely at this moment.

4. Gastrointestinal Tract: Sometimes, bleeding from the upper gastrointestinal tract can manifest as blood in saliva, especially if there is significant irritation or bleeding in the esophagus or stomach.

Given your symptoms, it’s crucial to monitor the situation closely. If the blood persists, increases in quantity, or is accompanied by other symptoms such as difficulty breathing, chest pain, or severe discomfort, you should seek immediate medical attention.
In your case, since the blood has diminished and you are feeling better after drinking water, it may not be an emergency. However, it is advisable to follow up with your healthcare provider during your next appointment. They may want to conduct further evaluations, such as a throat examination or possibly imaging studies, to rule out any underlying issues.

In summary, while the presence of blood in saliva can be concerning, it is often related to less severe causes, especially if it is transient and resolves quickly. However, due diligence is essential, and keeping your healthcare provider informed about your symptoms is the best course of action. If you experience any worsening symptoms or new developments, do not hesitate to seek immediate care.

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