What Does It Mean if You Cough Up Blood?

Reviewed on 11/11/2020

What Causes Coughing Up Blood?

Coughing up blood (hemoptysis) can be caused by a number of conditions, some of which are serious. See a doctor if you cough up blood to determine the underlying cause.  

Call 911 and get to a hospital’s emergency department if you cough up blood and:

  • You had trauma or injury to the chest
  • More than a one teaspoon of blood is coughed up
  • Blood is also in the urine or stool
  • If you are taking blood thinning medications (anticoagulants)
  • It is accompanied by chest pain, fever, dizziness, lightheadedness, or shortness of breath

Causes of coughing up blood that are non-life-threatening include: 

  • Airway diseases
  • Pulmonary parenchymal diseases 
    • Infection, such as tuberculosis, mycetoma, lung abscess, and necrotizing pneumonia 
    • Rheumatic and immune disorders, such as anti-glomerular basement membrane (i.e., Goodpasture) syndrome, lupus pneumonitis/vasculitis, granulomatosis with polyangiitis, microscopic polyangiitis, primary antiphospholipid antibody syndrome, Behçet syndrome, pulmonary capillaritis, and idiopathic pulmonary hemosiderosis
    • Genetic disorders of connective tissue, such as Ehlers-Danlos syndrome
    • Catamenial hemoptysis
  • Pulmonary vascular disorders 
    • Elevated pulmonary capillary pressure 
    • Pulmonary arteriovenous malformation (PAVM) 
    • Pulmonary or bronchial artery aneurysms, such as Hughes-Stovin syndrome, which may be a type of Behçet syndrome
    • Pulmonary artery pseudoaneurysms 
    • Pulmonary embolism (thrombotic, fat, septic) 
  • Trauma and bleeding disorders
    • Bleeding disorders, such as, thrombocytopenia, disseminated intravascular anticoagulation, platelet dysfunction syndromes, and von Willebrand disease, and use of anticoagulant or antiplatelet medications 
    • Airway or parenchymal trauma
    • Iatrogenic injury
  • Miscellaneous causes 
    • Drugs and toxins: habitual smokers of free-base cocaine ("crack"), levamisole-contaminated cocaine 
    • Bevacizumab treatment 
    • Nitrogen dioxide exposure in indoor ice arenas 
    • E-cigarette or vaping product use associated lung injury (EVALI) 
    • Other drugs: riociguat, hydralazine, and argemone alkaloid-contaminated cooking oil 
    • Idiopathic pulmonary hemosiderosis 
    • Fibrosing mediastinitis 
    • Pulmonary amyloid 

Common causes of coughing up blood that can be life-threatening include: 

  • Bronchiectasis 
  • Tuberculosis 
  • Fungal infections, such as aspergilloma and invasive parenchymal fungal infections 
  • Bronchogenic cancer 

Uncommon causes of coughing up blood that can be life-threatening include:

  • Other lung infections such as bacterial lung abscess and/or necrotizing pneumonia
  • Immunologic lung diseases, such as anti-glomerular basement membrane (anti-GBM; Goodpasture) disease, granulomatosis with polyangiitis, systemic lupus erythematosus (SLE), idiopathic pulmonary hemosiderosis, primary antiphospholipid antibody syndrome, Behçet syndrome, and microscopic polyangiitis
  • Chemotherapy and bone marrow transplantation
  • Pulmonary vascular diseases 
  • Acquired and iatrogenic trauma (trauma from a medical procedure)
  • Posterior arterial nosebleeds
  • Penetrating, rather than blunt, trauma 
  • Right heart catheterization (i.e., pulmonary artery catheterization) 
  • Medical interventions, including percutaneous or transbronchial lung biopsy, cryobiopsy, central vein venipuncture during pacemaker insertion, and ablative procedures for endobronchial masses. 
  • Fistulas, such as fistulas between the aorta and the airway 
  • Acute bronchitis 

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Reviewed on 11/11/2020