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Coughing Up Blood (Hemoptysis)

Hemoptysis (huh·MAAP·tuh·suhs) is the medical term for coughing up blood. It happens in adults with cystic fibrosis (CF) more than in young children. Regardless of age, it can be a scary side effect of CF.

About half of all adults with CF occasionally find streaks of blood in their mucus. A small number of those with CF over age 15 will cough up large amounts of blood. A large amount is considered to be 1 cup (8 ounces) over 20 minutes.1,2

What causes hemoptysis in people with cystic fibrosis?

Lung infections are most often the root cause of why someone with CF coughs up blood. An increase in infection in one area of the lung can cause a small blood vessel to burst during coughing. This makes blood come up with mucus after coughing.1

How is hemoptysis diagnosed?

Usually, people with CF who cough up blood self-report the condition to their CF team. The seriousness of hemoptysis is indicated by the quantity of blood in the mucus:2

  • Scant hemoptysis: Streaks in the mucus
  • Mild to moderate hemoptysis: Anything more than streaks and less than 1 cup
  • Massive hemoptysis: More than 1 cup

Anyone with scant to mild blood in their mucus should call their doctor, especially if it has happened for the first time.2

How is hemoptysis treated?

When a person with cystic fibrosis is experiencing hemoptysis, treatment will depend on how much blood is coming up.

Scant hemoptysis

Minor streaks of blood in the mucus may not need to be treated with antibiotics if there are no other signs of a pulmonary exacerbation. Some people may need to stop taking NSAIDS pain relievers for a time. Airway clearance should continue, or increase if the doctor recommends it.

Mild to moderate hemoptysis

Mild to moderate hemoptysis will need to be treated with antibiotics, just like any lung infection. NSAIDS pain relievers should be stopped because these can make bleeding worse. Extra vitamin K to prevent blood clots may be suggested for some people.1

There is some disagreement about airway clearance in people who are coughing up mild-to-moderate amounts of blood. Some doctors believe the vest, chest physical therapy, and positive expiratory pressure may be too aggressive for delicate lung blood vessels. Others believe the risks of stopping airway clearance outweigh the benefits of managing the bleeding.2

Massive hemoptysis

People who are coughing up large amounts of blood (more than 1 cup) should talk with the CF team right away. A hospital stay and intravenous (IV) antibiotics will be needed. A blood transfusion may be necessary for someone who have lost large amounts of blood. Airway clearance techniques and the use of aerosolized hypertonic saline should stop.1,2

If more serious bleeding continues, a surgery called a pulmonary artery embolization, may be required to stop the bleeding. Embolization plugs the bleeding blood vessel.2

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