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Haemoptysis

Coughing of blood, usually from the lung, is a distressing problem which is most often associated with lung cancer. Other sources of blood may be the oropharynx or gastrointestinal tract. Other common conditions which can be associated include infection, bronchiectasis, and pulmonary embolus or pulmonary infarct. Bleeding disorders may also contribute. [1]

Haemoptysis may be minor or massive; massive haemoptysis may be a life-threatening or a terminal event.

What is known

External beam radiotherapy or brachytherapy should be considered to palliate haemoptysis due to lung cancer. [2]

There are some studies to support the treatment of bleeding in cancer with antifibrinolytic agents, such as tranexamic acid [3-4] but high level evidence is lacking.

What it means in practice

  • Patients with significant haemoptysis from a lung malignancy should be offered radiotherapy and / or antifibrinolytics as clinically appropriate.
  • Aggressive management of massive haemoptysis (which may involve bronchoscopy and/or intubation, embolisation, or surgery) may not be appropriate when patients have advanced disease. If the patient is at risk of haemoptysis as a terminal event, plans for how this is to be managed to minimise distress to patient, family and caregivers need to be addressed. [4]
PubMed Searches
  1. Ripamonti C, Fusco F. Respiratory problems in advanced cancer. Support Care Cancer. 2002 Apr;10(3):204-16. Epub 2001 Aug 14.
  2. Kvale PA, Simoff M, Prakash UB; American College of Chest Physicians. Lung cancer. Palliative care. Chest. 2003 Jan;123(1 suppl):284S-311S.
  3. Dean A, Tuffin P. Fibrinolytic inhibitors for cancer-associated bleeding problems. J Pain Symptom Manage. 1997 Jan;13(1):20-4.
  4. Pereira J, Phan T. Management of bleeding in patients with advanced cancer. Oncologist. 2004;9(5):561-70.

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Last updated 18 January 2017