Coughing Up Blood

WHEN TO SEE YOUR DOCTOR

* In the absence of a cold or the flu, you notice small spots or streaks of red in your phlegm.

* You also have a fever, pain in the chest and shortness of breath.

* Your phlegm is very red or you cough up what seems to be blood more than once.

What Your Symptom Is Telling You

At the very least, it might be a nosebleed. At the very worst, it might be a serious lung problem. Either way (and anywhere in between), coughing up blood should be taken seriously, even though it may not be.

The presence of blood in your sputum or phlegm usually indicates at least a little bleeding in your respiratory tract somewhere between your nose and the bottom of your lungs. An innocuous nosebleed, for example, might cause some red postnasal drip that you cough up, according to Richard L. Sheldon, M.D., a pulmonologist and internist at Beaver Medical Clinic in Banning, California. But bleeding from anywhere other than your nose is more problematic. A harsh coughing spell, for example, could have ruptured a blood vessel in your lung, according to Charles P. Felton, M.D., chief of pulmonary medicine at Harlem Hospital Center and a clinical professor of medicine at Columbia University College of Physicians and Surgeons in New York City. "Many times you'll also see blood in early viral infections," he says.

Bronchitis and certain strains of pneumonia may cause blood vessels in the lungs to bleed, Dr. Sheldon says. So can blood clots and swelling of lung tissue caused by heart problems. At the worst, tuberculosis and lung cancer could produce bloody phlegm, Dr. Sheldon says.

The source of the blood isn't always confined to the respiratory tract. You could also be bleeding in your stomach and coughing it up, Dr. Sheldon says.

If the blood is a fresh bright red, you're still bleeding. If it's a darker red, or perhaps brown or rust-colored, the blood has dried or clotted. In less serious cases, the blood will appear as small red dots or flecks in the mucus, says Dr. Felton. In more serious cases, the blood may appear as streaks or clots, or it could just well up in the mouth, Dr. Sheldon says.

Symptom Relief

You can't put a tourniquet on bloody sputum. Either the blood disappears harmlessly soon after it appears, or you continue to cough it up, and you're on your way to the doctor's office. In either case, here's what you need to do.

Keep an eye on it. If you have a bad cold or a viral infection and you notice a few spots of blood in your mucus, Dr. Felton says to stay vigilant: Watch out to see if it happens again or gets worse. If it does, see your doctor.

Don't block the blood. Don't take an over-the-counter cough suppressant to stifle your blood-tinged sputum, cautions Sally E. Wenzel, M.D., an assistant professor of medicine at the National Jewish Center for Immunology and Respiratory Medicine in Denver. By treating yourself, you might be allowing blood to pool somewhere inside your body, and you could be masking a sign of a serious problem. Your doctor may decide you need a cough suppressant so you don't aggravate whatever might be producing the blood, but let that be his or her option.

Cough into a container. If you cough up blood more than once or are worried enough by what you see to go to the doctor, make sure you take along a sample of the phlegm for testing, says Dr. Wenzel. If it's an infection, the test will ensure that you get the right antibiotic.