Blood in Phlegm: Causes and When to See an ENT - Otolaryngology

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Coughing up blood?


Hello, Doctor.
I often experience nasal allergies, and after blowing my nose, I have a habit of rolling up tissue and inserting it into my nostrils to clean them thoroughly.
Recently, when I pulled the tissue out, there was always blood on it, but I didn't have a full-blown nosebleed.
Recently, while I was sick and coughing up phlegm, I noticed that when I inhaled forcefully through my nose, it felt more like I was sucking mucus back in along with the phlegm.
As a result, the phlegm I coughed up was mixed with blood, which made up about half of it.
I would like to ask if this could indicate a serious issue.
Should I see an otolaryngologist for a check-up? Thank you in advance for your response, Doctor.

Liu Xiansheng, 20~29 year old female. Ask Date: 2008/03/26

Dr. Hu Kexin reply Otolaryngology


Hello: There are many causes for mucus or phlegm containing blood, including injury to the nasal mucosa, nasopharyngeal cancer, or other reasons.
It is recommended that you see an otolaryngologist as soon as possible for an examination.
Wishing you good health, Dr.
Hu Ksin, Department of Otolaryngology, Keelung Hospital.

Reply Date: 2008/03/26

More Info


Blood in phlegm can be concerning, and it’s important to understand the potential causes and when to seek medical attention. Given your history of nasal allergies and the recent symptoms you've described, let's break down the situation.

Firstly, the presence of blood in your phlegm can arise from several sources. In your case, since you mentioned frequent nasal allergies and the habit of using tissues to clean your nose, it’s possible that the blood could be originating from the nasal passages. Allergic rhinitis can lead to inflammation and irritation of the nasal mucosa, which may cause small blood vessels to rupture, especially if you are forcefully blowing your nose or using tissues aggressively. This could explain the blood you noticed on the tissue.

When you mention that you are experiencing blood in your phlegm after a forceful attempt to clear your throat or nasal passages, it raises the possibility that the irritation may have extended to the throat or bronchial tubes. The act of forcefully sucking mucus back can create pressure that might lead to minor bleeding in the respiratory tract, which could mix with the phlegm.

However, while minor bleeding can be benign, it’s essential to be vigilant. Blood in phlegm can also indicate more serious conditions, such as infections (like bronchitis or pneumonia), chronic conditions (like chronic obstructive pulmonary disease), or even more severe issues like pulmonary embolism or lung cancer, especially if the bleeding persists or is accompanied by other symptoms like significant coughing, chest pain, or shortness of breath.

Given your symptoms, it is advisable to consult an Ear, Nose, and Throat (ENT) specialist. An ENT can perform a thorough examination of your nasal passages, throat, and possibly your lungs to determine the source of the bleeding. They may use tools like a nasal endoscope to visualize the nasal cavity and throat more clearly. If necessary, they might also recommend imaging studies, such as a chest X-ray or CT scan, to rule out any underlying conditions in the lungs.

In the meantime, here are some general recommendations to help manage your symptoms and reduce the risk of further irritation:
1. Avoid Forceful Nose Blowing: Be gentle when clearing your nose to prevent further irritation or bleeding.

2. Stay Hydrated: Drinking plenty of fluids can help keep your mucus thin and easier to expel.

3. Use a Humidifier: Keeping the air moist can help soothe irritated nasal passages.

4. Avoid Allergens: If you know what triggers your allergies, try to minimize exposure to those allergens.

5. Nasal Saline Rinse: Using a saline nasal spray or rinse can help keep your nasal passages moist and clear out irritants.

If the bleeding continues, worsens, or if you develop additional symptoms, do not hesitate to seek medical attention promptly. It’s always better to err on the side of caution when it comes to health concerns. Remember, while some causes of blood in phlegm can be benign, others may require immediate medical intervention.

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