Bloody Sputum: What It Looks Like and What Causes It

You don't always notice blood in sputum right away: sometimes it's just a thin streak on a tissue, sometimes it's frothy bright red blood. Coughing up blood from the larynx, bronchi, or lungs is called hemoptysis by doctors. It has many causes, and some of them are serious, so this symptom is never ignored.

What Bloody Sputum Looks Like: Streaks, Bright Red and Rusty

Blood that comes up with a cough is usually mixed with air and mucus, so it looks frothy. It is most often bright red, but it can also be rusty in color. Sometimes only streaks of blood are visible in the mucus. The color can give a rough idea of the source: bright red frothy blood suggests bleeding from the airways, while dark red, coffee-colored blood suggests bleeding from the gastrointestinal tract. Mucus with streaks of blood from the nose or paranasal sinuses sometimes mimics hemoptysis. Hemoptysis is not the same as bleeding from the mouth, throat, or digestive tract.

Coughing Up Blood with a Cold and Bronchitis

Common causes include a prolonged or severe cough, as well as infections of the lungs and airways: bronchitis, pneumonia, tuberculosis. Bronchitis is among the causes of hemoptysis, and a severe cough can irritate the throat and produce a small amount of blood. Even if it seems to be just a cold, blood in sputum should be checked by a doctor.

Other Causes of Hemoptysis

The list is broad: bronchiectasis, lung cancer, a blood clot in the lung, pulmonary edema, inflammation of the lung vessels, injuries, food entering the airways. Hemoptysis can occur with anticoagulant use, congestive heart failure, and mitral stenosis. In children, it is often caused by a foreign body in the airways. Rarer causes include cystic fibrosis, systemic lupus erythematosus, vasculitis, Goodpasture syndrome, and Wegener granulomatosis.

Bloody Sputum Without a Cough and in the Morning

If blood is noticed without a cough, the doctor will check where it comes from: the airways, the nose, or the digestive tract. If blood appears in the morning, the doctor will ask whether there was a severe cough at night. Coughing up blood without other symptoms still requires an examination: the cause cannot be determined from the appearance of the sputum alone.

How a Doctor Determines the Cause

The doctor will ask how much blood there is, how often it happens, whether there are other symptoms, and whether you take blood-thinning medications, and will examine the chest. Possible tests include chest X-ray, computed tomography, bronchoscopy, sputum analysis, complete blood count, coagulation assessment, and lung biopsy.

• Chest X-ray and CT
• Bronchoscopy to examine the airways
• Sputum analysis and culture
• Complete blood count and coagulation tests

When Emergency Help Is Needed

A small amount of blood by itself is not a reason to call an ambulance; call 103 or 112 if you cough up more than a few drops or streaks, if you have difficulty breathing, a very fast pulse, chest or upper back pain, dizziness, or blood in your urine or stool.

Even a few small streaks are a reason to make an appointment with a doctor soon. This material is for reference and does not replace a doctor's consultation: only a doctor can assess your situation as a whole.

This content is for reference and does not replace a doctor's consultation. Medical disclaimer