The prospect of drowning in one’s own blood

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Dr Jones Nghaamwa
Windhoek

Haemoptysis which refers to the coughing up of blood is usually a symptom of disease (pathology) within the lower breathing circuit (airways), the lungs or systemically.  

The quantity of blood coughed up varies from small specks of blood in the sputum to large volumes.  Massive haemoptysis or coughing up large volumes of blood may compromise the well-being of the individual affected.

 Coughing up blood needs to be differentiated from vomiting blood or bleeding from the upper airways including from nosebleeds.
Underlying disease that may lead to a person coughing up blood are variable.  Broadly they can be categorised as:

A) Diseases affecting the lower airways
B) Diseases of the lung substance
C) Disease involving blood vessels to and from the lungs
D) Illnesses of the heart
E) Others

Commonly encountered problems in Namibia are lung infections, structural changes of the lungs as a result of previous lung tuberculosis and lung cancer.  

Coughing up blood is thus a symptom that should not be ignored.  Even small volumes of blood coughed up should prompt the individual to seek medical attention with the aim of investigating and diagnosing the underlying cause.  Recurrent coughing up of small amounts of blood may herald an episode involving a significant bleed with large volumes coughed up. Such a massive bout of haemoptysis can result in blood filling the airways of both lungs causing the person to “drown in their own blood”.  If large volumes of blood are coughed up in a single bout, the individual’s life is at significant risk.

Medical attention should be sought early to prevent potential complications from haemoptysis.  Massive haemoptysis is usually dramatic and scary to the individual with the result this category inevitably results in the person presenting to a hospital emergency department.  Various investigations are performed to identify the underlying cause.

Imaging of the chest (X-rays and CT scanning) is essential for the diagnosis of many of the pathologies that may lead to coughing up blood.  

Various modalities are used for the treatment of this manifestation (haemoptysis).  It is essential that bleeding should be aborted where possible. Importantly, the individual’s life should be safeguarded by protecting his breathing pipes from being obstructed by blood.  Treatment considers and is directed to the underlying disease and the prevailing clinical circumstances.

In a nutshell, coughing up blood is a sign of potentially serious disease and medical attention should be sought as soon as possible.  When large blood volumes are coughed up, a true medical emergency exists and threat to life is significant.

* Dr Jones Nghaamwa is a cardiothoracic, heart and lung surgeon at Windhoek Central Hospital and Lady Pohamba Hospital.

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