HEMOPTYSIS
Submitted by Tammy L. Crandall, CHUC, of
Learning
Objectives:
1. Define hemoptysis.
2.
Identify some of the causes of hemoptysis.
3.
List two treatment options for hemoptysis.
What is
Hemoptysis?
Hemoptysis
is derived from the word “hamia” which means blood and “ptysis” which means
spitting. The meaning is the act of
coughing up blood or sputum containing blood as a result of a pulmonary or
bronchial hemorrhage. This blood is
derived from the lungs or bronchial tubes and refers to the respiratory
tract. This is an important symptom
because it reflects a serious underlying lung disease.
Causes
There are
many underlying causes of hemoptysis, but the most common ones are infections,
drug abuse, tumors, vascular disorders, bronchitis (acute and chronic),
pneumonia, lung cancer, and foreign object(s) in the airway. The most common worldwide cause is
tuberculosis.
Doctors
may use different procedures to determine the causes of hemoptysis. Laboratory work such as a complete blood
count and coagulation studies should be ordered to confirm the diagnosis,
sputum cytology to rule out the risk of lung cancer, a chest x-ray, which may
help in suggesting the source of the hemoptysis (i.e., pulmonary inflammatory
disease or cancer), a chest CT scan which produces more detailed pictures than
a normal chest x-ray and is more sensitive to abnormalities that may not be
present on the chest x-ray.
Treatment
Treatment
will depend on the cause and the quantity of blood. The quantity of blood is classified as a
non-massive or massive/major depending on the loss of blood. If the loss of blood is less than 200ml per
day, then it is non-massive. If the
blood loss is greater than 200ml per day, then it is massive/major and is an
emergency.
Non-Massive
Blood Loss
Managing a
patient with hemoptysis is threefold: bleeding cessation, aspiration
prevention, and treatment of the underlying cause. The goal is finding and treating these causes
by evaluating the ABC’s (i.e., airway, breathing and circulation). Low-risk patients and those patients who
present with acute, mild hemoptysis caused by bronchitis can be closely
monitored and treated on an outpatient basis with the appropriate oral
antibiotics. If the symptoms persist, or
are still unexplained, one should consider seeing a pulmonologist.
Massive
or Major Blood Loss
This warrants
a more aggressive and expedient approach especially in the example of
hemoptysis greater than 1000ml in a 24hour period. It carries a mortality rate of 80% with
malignancy present. These patients
require intensive care with a pulmonologist and cardiothoracic surgeon consulting. In case hemoptysis is life-threatening,
airway maintenance, supplemental oxygen and fluid resuscitation are essential
because the primary mechanism of death is asphyxiation.
If the
underlying cause of the hemoptysis is unknown, then hemoptysis should be
carefully monitored for 2-3 years following initial treatment. It may mean having routine chest x-rays.
Resources:
http://www.aafp.org/afp/AFPprinter
http://www.pulmonologychannel.com/common
http://www.healthatoz.com/common/standard/transform.jsp
http://www.mayoclinic.com/print/hemoptysis
http://en.wikipedia.org/wiki/Hemoptysis
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Subject: Hemoptysis
Submitted by: Tammy L. Crandall, CHUC, of
Objective: To identify facts about hemoptysis
Resources: Accompanying article submitted by Tammy Crandall
Instructions: After reading the article, please circle the best
answer.
1.
What
is hemoptysis?
a.
filtering
blood
b.
coughing
up blood
c.
vomiting
up blood
d.
blood
originating outside the respiratory tract
2.
What
other type of bodily fluid may be involved with hemoptysis?
a.
urine
b.
stool
c.
sperm
d.
sputum
3.
What
are some of the causes of hemoptysis?
a.
tuberculosis
b.
tumor
c.
pneumonia
d.
all
of the above
4.
What
types of procedures are used to diagnosis hemoptysis?
a.
labs
b.
electrocardiogram
c.
chest
X-ray
d.
both
A & B
e.
both
A & C
5.
Which
of the following lab test would probably not
be ordered for a patient with hemoptysis?
a.
CBC
b.
Clotting
time
c.
Creatinine
d.
Pro-time
6.
Non-massive
blood loss is the amount of blood less than _____ml?
a.
200
b.
1,000
c.
500
d.
300
7.
Which
of the following would probably not
be included in the management of hemoptysis?
a.
controlling
bleeding
b.
implementing
hemodialysis
c.
treatment
of the cause of bleeding
d.
preventing
aspiration
8.
In
this article, the ABC’s refer to:
a.
airway,
breathing and circulation
b.
always
be careful
c.
achieve
bleeding cessation
d.
aspirate,
bleeding, and cauterization
9.
Which
of the following would be considered a massive blood loss?
a.
more
than 1 liter in a 24 hour period
b.
more
than 1000 ml in a 48 hour period
c.
more
than 500 ml in a 24 hour period
d.
more
than half a liter in a 48 hour period
10.
For
how many years should hemoptysis be carefully monitored if the cause is
unknown?
a.
5-10
b.
1-4
c.
10-12
d.
2-3