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Approach To Hemoptysis

1) The document provides guidance on evaluating and treating hemoptysis. It outlines steps to determine if the patient truly has hemoptysis versus similar conditions, and to classify the severity as massive or not massive. 2) Potential causes of hemoptysis are discussed, including lung conditions like bronchiectasis and infection, as well as vascular issues and iatrogenic or hormonal influences. 3) Recommended initial investigations include chest x-ray to identify abnormalities, blood tests to check for coagulopathy, and sputum analysis to detect infections. Oxygen saturation should also be assessed.

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YuanYuh Leong
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68 views2 pages

Approach To Hemoptysis

1) The document provides guidance on evaluating and treating hemoptysis. It outlines steps to determine if the patient truly has hemoptysis versus similar conditions, and to classify the severity as massive or not massive. 2) Potential causes of hemoptysis are discussed, including lung conditions like bronchiectasis and infection, as well as vascular issues and iatrogenic or hormonal influences. 3) Recommended initial investigations include chest x-ray to identify abnormalities, blood tests to check for coagulopathy, and sputum analysis to detect infections. Oxygen saturation should also be assessed.

Uploaded by

YuanYuh Leong
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Approach to Hemoptysis

History
1) Confirm if really hemoptysis
a. Hemoptysis- blood coughed up, often bright red, might be mixed
with sputum
b. Hematemesis- blood vomited from upper GIT, can be coffee ground
coloured due to gastric digestion
c. Epistaxis: bleeding from nasopharynx
2) Massive or not massive
a. There is no fix definition of massive hemoptysis, but it can be taken
as 150ml/24 hours (volume of lung reserve)
b. Cup, teaspoon, blood streaks
c. Clot
3) Identify causes
a. Lung
i. Bronchiectasis
1. Long standing productive cough, previous smoking
history
2. Blood streaked- if capillary plexus rupture
3. Bright red- if bronchial artery rupture
ii. Infection
1. TB granuloma due to erosion/necrosis
a. TB contact
b. Previous pTB
c. Chronic cough, LOA, LOW, Night sweats
2. Abscess- foul smelling bloody sputum
iii. Cancer
1. Due to invasion into vessels or tumor necrosis
2. Constitutional symptoms
iv. Inhalation injury
1. Fire smoke, chemicals, substance abuse
2. Exposure
b. Vasculature
i. Cardiac- elevated pulm capillary pressures may cause
alveolar capillary rupture- PINK AND FROTHY SPUTUM
1. Heart failure (acute)- AMI, Myocarditis
a. PND, Orthopnea, reduced effort tolerance, leg
swelling
2. Aorto pulmonary fistula
ii. Rheum
1. Vasculitis- diffuse alveolar hemorrhage in ANCA
vasculitis, SLE
iii. Hematological
1. Coagulopathy
2. PE- hemoptysis due to local parenchymal infarct
c. Iatrogenic- post instrumentation
d. Pulmonary endometriosis

Investigations

Identify cause
o CXR- obvious abnormalities such as nodules indicating possible
malignancy, or infection

Heme: FBC, PT/PTT, GXM


Sputum studies: gram smear and culture, AFB smear and culture,
AFM PCR
Assess oxygenation:
o SpO2
o ABG
o
o

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