Hemoptysis grading criteria
Nov 04, 2022
Source: Cainiu Health
Dr. Guo Xiheng
Introduction
The amount of hemoptysis can be classified as mild, moderate, or massive. The patient's room should be kept quiet, clean, and comfortable. Patients with moderate to massive hemoptysis should remain in bed (patients with massive hemoptysis must have absolute bed rest) and avoid emotional anxiety and tension as much as possible. If a patient with massive hemoptysis experiences asphyxiation, family members should quickly assist the patient into a head-down, feet-up position and immediately call the emergency number 120.
Hemoptysis refers to bleeding from the larynx, lower respiratory tract, or lung tissue, which is expelled through the mouth, manifesting as blood-tinged sputum or coughing up fresh blood. Clinically, hemoptysis is classified into mild, moderate, and massive based on the volume of blood expectorated.
1. Mild hemoptysis
This usually presents as blood-streaked sputum or a small amount of hemoptysis, with less than 100 mL of blood per day. It is commonly seen in patients with bronchitis, pneumonia, or bronchogenic carcinoma.
2. Moderate hemoptysis
Daily blood loss ranges between 100 and 500 mL. Prior to bleeding, patients often experience warning symptoms such as throat irritation, chest tightness, and coughing. The expectorated blood is typically bright red, mixed with foam or sputum, and alkaline in nature. This type is frequently observed in patients with bronchial foreign bodies, trauma, bronchiectasis, or pulmonary tuberculosis.
3. Massive hemoptysis
Defined as more than 500 mL of blood expectorated per day, or a single episode exceeding 100 mL. It is often accompanied by choking cough, rapid weak pulse, cold sweats, tachypnea, pallor, restlessness, and a sense of fear. Massive hemoptysis commonly occurs in conditions such as cavitary pulmonary tuberculosis and bronchiectasis.
In cases of bronchogenic carcinoma, massive hemoptysis is rare and blood-tinged sputum is more typical. Chronic bronchitis may present with blood-tinged or bloody sputum, often associated with severe coughing. In young and middle-aged adults, hemoptysis is commonly due to bronchiectasis or pulmonary tuberculosis. However, in individuals over 40 years old with a long history of smoking, bronchogenic carcinoma should be highly suspected.
The amount of hemoptysis does not always correlate directly with disease severity; however, massive hemoptysis requires immediate emergency intervention, as it can be life-threatening.
