Understanding Hempotysis

In its simplest definition, hemoptysis is blood in the sputum. When it happens for the first time, hemoptysis is more than a little frightening. Hemoptysis is usually a symptom of something else going on in the lugs. Any of the following may be the underlying cause of the bleeding:

• Infection
• Dryness
• Reaction to a particular nebulizer treatment (e.g. Pulmozyme or Hypertonic saline)
• Bronchiectasis
  
• Vitamin K deficiency
• Overexertion

Infection is the leading cause of hemoptysis. When the bronchial arteries become swollen and inflamed in response to an infection, they may burst and bleed. Unless the bleeding is massive (i.e. more than a few tablespoons in an hour) then this is rarely cause for alarm. It's just one of the frightening and unpleasant side effects of cystic fibrosis. Bleeding in the lungs may also occur when the tissue and blood vessels of the lungs becomes particularly damaged, after many subsequent infections or bouts of pneumonia.

Hemoptysis may also be the result of an adverse reaction to Pulmozyme or hypertonic saline inhalation treatment. Some cystic fibrosis patients simply cannot tolerate Pulmozyme. There are a number of studies that have demonstrated that a specific component of Pulmozyme, (DNase I) triggers lung hemorrhage.


Occasionally the bleeding is simply the result of overexertion during the usual process of airway clearance. Coughing too hard or too long may cause a small bleed. This type of bleeding clears up on its own in a relatively short period of time. The same is true for bleeding that is the result of the lungs being exposed to dry air. Some women also report brief episodes of hemoptysis during menstruation.

When an episode of hemoptysis has occurred, be sure to mention it to the doctor at your next appointment. Your doctor can adjust your medications if they are triggering the bleeding, or prescribe something to address an underlying infection. When describing the episode to your health care provider, be sure to note whether you coughed up dried blood streaked through your sputum, or if it was only bright red blood. Always be able to give a good estimation of how much blood was present.