Dear Doctor,

I am battling a cold and cough but I am scared because my spittle at times contains blood. What causes this? Could there be a more complicated underlying problem? Janvier

Dear Janvier,

Presence of blood in spittle is indeed very frightening. It could be due to multiple reasons, many of which are curable. What is the quantity of blood present in the sputum? Is there associated chest pain, fever, loss of appetite, e.t.c. symptoms?

Acute upper respiratory tract infections can cause blood mixed sputum, due to severe irritation and inflammation of the pharyngeal wall. It can be due to infections of the lower respiratory tract, i.e. the lungs (pneumonia) and air tubes (bronchitis) and air sacs. Acute infections of the lungs causes blood in sputum as one of the manifestations. The quantity of blood depends on size of blood vessel affected. Along with hemoptysis(blood in sputum), there is high grade fever and chest pain on affected side with breathlessness. Viral pneumonias subside spontaneously in a week or 10 days. But bacterial pneumonias need suitable antibiotics for cure. Infections like T.B. of the lungs, produce a chronic illness, where there are associated symptoms of low grade night fever, night sweats, loss of appetite and loss of weight. It can also be due to fungal infections like aspergillosis, histoplasmosis, where cough and bloody expectoration with chest pain are the predominant symptoms.

Blood mixed sputum is also caused due to presence of a clot in the lungs, where there is also severe chest pain and breathlessness. It can be one of the manifestations of auto immune disorders like sarcoidosis. The other manifestations are dryness and tightness of skin of the face and joints pain. Tumors of the lungs, whether benign or malignant often cause hemoptysis.

Presence of fluid in the lungs due to heart, kidney or liver failure, is manifested by breathlessness and cough with frothy and blood mixed expectoration. A heart attack can also have blood mixed sputum, but there are other symptoms like acute onset of excruciating chest pain, breathlessness, sweating and restlessness.

At times, small quantity of blood in the spittle can be a side effect of drugs used to stop blood clotting like aspirin. It can be the manifestation of a disorder of bleeding like low platelet counts.

The cause of hemoptysis can be ascertained by a complete blood count, measurement of erythrocyte sedimentation rate(E.S.R.), X-ray chest, and other relevant investigations. Treatment depends on underlying cause. Mild hemoptysis needs no intervention. However if quantity of blood lost is much, it needs urgent treatment. Medicines are given to stop bleeding, either in tablet or injection form. Severe hemoptysis needs interventions like coagulation or ligation of bleeding vessels.