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Monday, 2 December 2013

Hemorrhaging - Hemoptysis - The Causes

Hemorrhaging is also known as bleeding or abnormal bleeding as a result of blood loss due to internal.external leaking from blood vessels or through the skin.
Hemoptysis
 Hemoptysis is defined as a condition of coughing up blood from the bronchi, larynx, trachea, or lungs.
Causes
2.1. Cystic fibrosis (23%), bronchiectasis (13%), tuberculosis sequelae (8%), chronic obstructive pulmonary disease (COPD)(6%)
According to the study of researchers at the Università degli Studi di Milano. Ospedale San Paolo, the causes of haemoptysis was as follows: cystic fibrosis (23%), bronchiectasis (13%), tuberculosis sequelae (8%), chronic obstructive pulmonary disease (COPD) (6%) and no apparent cause (21%). Major complications were recorded in 3/477 (0.6%): stroke (n=1), transient ischaemic attack (TIA) (n=1) and transient quadriplegia (n=1). Minor complications were recorded in 143/477 (30%): chest pain 86/143 (60%) and dysphagia 29/143 (20%). During a mean follow-up period of 14 (8-36) months, haemoptysis recurrence was observed in 42/110 cases (38%) of cystic fibrosis and in 77/367 cases of other diseases (21%)(2).

2.2. Thrombasthenia is a rare disorder of blood platelets, which results in easy bruising and nosebleeds.

2.3. Blood clot in the lung 
Blood clot in the lung due to Venous thrombosis, as a result of  blood clot formed in a vein breaks off and transported to the right side of the heart into the lungs. must be coughed out for the normal function of the lung. There is a report of a young woman diagnosed as having microscopic polyangiitis (MPO) presenting with diffuse alveolar hemorrhage (DAH). DAH is a rare, but life-threatening disorder. The patients presented with dyspnea, cough, hemoptysis (not constant). The radiographic features are very characteristic and reveal the signs of diffuse, bilateral alveolar filling in chest HRCT especially in middle and lower zones(3).

2.4. Bronchiectasis and Tuberculosis
There is a report of a 39-year-old woman presented with chronic cough, haemoptysis and hoarseness of voice. She had left recurrent laryngeal nerve palsy and high inflammatory markers on investigation. CT thorax revealed aortic wall thickening and traction bronchiectasis. 2 D echocardiogram revealed grade 1 aortic regurgitation compatible with aortitis(4). Other researchers in the study of 154 patients admitted for life-threatening hemoptysis (LTH) over 3 consecutive years. Bronchoscopy and arteriography procedures were performed, as prescribed by the attending physician. Patient evolution was followed 5 years post-event, wrote that teading causes of life-threatening hemoptysis (LTH) were bronchiectasis and tuberculosis. While bronchoscopy during a hemoptysis episode was effective in identifying the source of the bleeding, artery embolization was more effective in stabilizing the patient both at the short and long term(4a).

2.5.  Pulmonary edema 
Pulmonary edema has been reported in SCUBA divers, apnea divers, and long-distance swimmers. Researchers at the  University Boulevard, in the study of Immersion pulmonary edema in female triathletes, showed that Contributing factors include hemodynamic changes due to water immersion, cold exposure, and exertion which elevate cardiac output, causing pulmonary capillary stress failure, resulting in extravasation of fluid into the airspace of the lung(5).

2.6. Cystic fibrosis 
Cystic fibrosis (CF) is a recessive genetic disease characterized by dehydration of the airway surface liquid and impaired mucociliary clearance and Hemoptysis and pneumothorax are complications commonly reported in patients with cystic fibrosis(6).

2. 7. Esophageal and Lung cancer
If the tumor in the lung and Esophagus cause the break off of the blood vessels, it can cause coughing of blood to protect the respiratory system.

2.8. Esophageal and/or laryngeal candidiasis
Esophageal and/or laryngeal candidiasis can cause signs and symptoms of  hemoptysis(7).

2.9. Pneumonia 
There is a report of a 37-year-old man with hemoptysis, fever, and shortness of breath. The clinical and laboratory examinations revealed that the patient had pseudohemoptysis due to S. marcescens pneumonia, on an immunocompromised pattern, because of the coexistence of sarcoidosis, accoring to the study by General Hospital, Aristotle University of Thessaloniki(8).

2.10. Others
In the study of Hemoptysis: an uncommun case by Serviços de Medicina Interna e de Pneumologia, Hospital de Sousa Martin, researchers indicated that hemoptysis is a symptom that suggests a variety of pathologies that can be more or less benign and even fatal, a life threatening for the person who suffers it. Between the most common causes we have bronchitis, bronchiectasis and bronchopulmonary neoplasia. Less frequent causes are: Goodpasture's syndrome, Wegener's granulomatosis, systemic lupus erythematosus, between others(9). 
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Sources
(1) http://www.ncbi.nlm.nih.gov/pubmed/22791000
(2) http://www.nejm.org/doi/full/10.1056/NEJMcpc0708507
(3) http://www.ncbi.nlm.nih.gov/pubmed/22335144
(4) http://www.ncbi.nlm.nih.gov/pubmed/22905814
(4a) http://www.ncbi.nlm.nih.gov/pubmed/22704276
(5) http://www.ncbi.nlm.nih.gov/pubmed/21660230
(6) http://www.ncbi.nlm.nih.gov/pubmed/20675678
(7) http://www.ncbi.nlm.nih.gov/pubmed/7422428
(8) http://www.ncbi.nlm.nih.gov/pubmed/21941452
(9) http://www.ncbi.nlm.nih.gov/pubmed/18282444