Coughing Up Blood: Causes and Medical Guidance

For vomiting blood or coughing up blood, which medical specialty should be consulted?

I would like to ask about my father, who is 67 years old and has been coughing up blood.
He was hospitalized in the chest medicine department for two weeks.
After returning home, he seemed to recover for a few days, but then he started coughing up blood again.
What could be the cause of this? Could you please provide some answers? (He has chronic conditions including a history of stroke, diabetes, and hypertension.)
1.
Regarding the symptoms of coughing up blood, if there is no improvement, what diseases could he potentially have?
2.
What is the difference between vomiting blood and coughing up blood?

Zheng, 30~39 year old female. Ask Date: 2022/05/12

Dr. Hong Yuanbin reply Internal Medicine

Hello, I would like to ask if your father often experiences severe coughing or frequently produces phlegm? If so, this could be due to damage to the mucosal epithelium causing bleeding, which needs to be addressed along with the original cough issue and reducing the frequency of phlegm production, possibly by using expectorants.
Additionally, I wonder if he is currently on anticoagulant medications; if so, it may be necessary to consult a physician to adjust the medication.
If none of the above applies, your father may have some chronic lung conditions such as bronchiectasis or chronic bronchitis, which can also lead to hemoptysis that requires treatment of the underlying lung disease.
As for hemoptysis, it refers to gastrointestinal bleeding where a significant amount of blood is expelled from the mouth.
Thank you for your inquiry.

Reply Date: 2022/05/12

More Info

Coughing up blood, also known as hemoptysis, can be a concerning symptom, especially in older adults with pre-existing health conditions. In your father's case, at 67 years old and with a medical history that includes chronic illnesses such as stroke, diabetes, and hypertension, it is crucial to understand the potential causes and implications of this symptom.

1. Possible Causes of Coughing Up Blood:
Coughing up blood can arise from various conditions affecting the respiratory system. Some common causes include:
- Bronchitis: Inflammation of the bronchial tubes can lead to coughing and, in some cases, blood-streaked sputum.

- Pneumonia: This lung infection can cause coughing up blood, especially if the infection is severe.

- Tuberculosis (TB): A serious infectious disease that primarily affects the lungs and can cause significant coughing and hemoptysis.

- Lung Cancer: Given your father's age and medical history, lung cancer is a possibility that should be ruled out, especially if he has a history of smoking or exposure to carcinogens.

- Pulmonary Embolism: A blood clot in the lungs can cause sudden onset of hemoptysis and is a medical emergency.

- Chronic Obstructive Pulmonary Disease (COPD): This condition can lead to chronic cough and may result in blood in the sputum.

- Vascular Issues: Conditions affecting blood vessels in the lungs can also lead to bleeding.

Since your father has been hospitalized for this issue and has experienced a recurrence, it is essential to follow up with his healthcare provider for further evaluation. Persistent hemoptysis warrants comprehensive diagnostic testing, including imaging studies like a chest X-ray or CT scan, and possibly bronchoscopy to visualize the airways directly.

2. Difference Between Coughing Up Blood and Vomiting Blood:
It is important to differentiate between hemoptysis (coughing up blood) and hematemesis (vomiting blood).
- Coughing Up Blood (Hemoptysis): This blood typically comes from the lungs or airways. The blood may appear bright red or pink and is often mixed with mucus. The presence of a cough is a key indicator that the blood is coming from the respiratory tract.

- Vomiting Blood (Hematemesis): Blood that is vomited usually comes from the gastrointestinal tract. It may appear dark red or have a coffee ground appearance due to the digestion of blood. There is no accompanying cough in this case.

Given your father's chronic conditions and the recurrence of his symptoms, it is advisable to seek immediate medical attention if he experiences significant hemoptysis, especially if it is accompanied by other symptoms such as chest pain, difficulty breathing, or fever.
In summary, while coughing up blood can be alarming, understanding the potential causes and differences in symptoms can help guide appropriate medical care. It is crucial to maintain open communication with healthcare providers and ensure that your father receives the necessary follow-up care to address this serious symptom.

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