What is the standard for grading the amount of hemoptysis?
Nov 04, 2022
Source: Cainiu Health
Dr. Guo Xiheng
Introduction
Hemoptysis refers to bleeding from the lower respiratory tract or lung tissue below the larynx, which is expelled through the mouth as blood-streaked sputum or fresh bloody cough. Clinically, hemoptysis is classified into mild, moderate, and massive hemoptysis based on the volume of bleeding. The amount of hemoptysis does not always correlate directly with disease severity; however, massive hemoptysis requires emergency management, as it can be life-threatening if left untreated.
Hemoptysis refers to bleeding from the larynx, lower respiratory tract, or lung tissue, which is expelled through the mouth and manifests 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 small amounts 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 from 100 to 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 per day or a single episode exceeding 100 mL. It is often accompanied by choking cough, rapid and 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; the primary manifestation is usually blood-tinged sputum. Chronic bronchitis may present with blood-tinged or bloody sputum, often associated with severe coughing. In young or middle-aged individuals, hemoptysis is commonly due to bronchiectasis or pulmonary tuberculosis. However, in long-term smokers over 40 years of age, 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.
