Hemoptysis

Recently my sister had hemoptysis which her doctor described as minor. However, this situation is causing my family a lot of anxiety. Can you explain to us what hemoptysis is and how should we react if it happens again?

Hemoptysis is when blood from the lungs is expectorated by mouth. In the lungs of a person living with cystic fibrosis, chronic infection and inflammation change the pulmonary blood vessels by eroding their walls and dilating the bronchial arteries, making them more friable and vulnerable to bleeding. This is a relatively common complication and this situation can, of course, cause a lot of stress for both the person who experiences it and those around them.

If you experience hemoptysis, it is important to record the quantity to inform the medical team who can determine the urgency of the situation. Treatment will vary depending on the severity of the situation. This may be simple monitoring (with or without antibiotics), embolization (blockage of the blood vessels where the bleeding comes from), or in rare cases, surgery.

There are three types of hemoptysis: minor, major, and massive.

• Minor hemoptysis (<5ml): The quantity of blood may vary during the day. It can be simple traces of blood in the secretions or about a teaspoon of liquid blood. It is the most frequent. Recommendation: Contact your cystic fibrosis clinic. If the expectorated blood is bright red and/or persists and/or is accompanied by an increase in your respiratory symptoms, it is best to see your doctor quickly. It is possible, especially if this is the first time this has happened to you, that your doctor may decide to examine you. Although in most cases mild hemoptysis does not require treatment, it is recommended that you tell the members of your CF team. Antibiotic therapy may be required if there is an underlying lung infection.

• Major hemoptysis (<240ml): It can be defined by the expectoration of a quantity of liquid blood of a few teaspoons, over a period of 24 hours.

• Massive hemoptysis (>240ml): It is a serious situation that requires urgent care. The amount of blood that is coughed up can easily reach up to 1-2 cups or more over a 24-hour period. It can happen quickly and without any prior symptoms.

Recommendation: If any of these situations occur, either major or massive hemoptysis, you should go to the hospital quickly and notify your CF team. In all cases, antibiotic therapy will be started and you will remain under medical observation. In cases of persistent major hemoptysis and massive hemoptysis, it is recommended to embolize the bronchial arteries that are responsible for the bleeding. Your doctor will discuss with you the best course of action for your condition.

People who have hemoptysis are always at risk of a new episode. Although there is no way to prevent massive hemoptysis, adhering to your medical treatments to prevent lung infections may reduce the risks.

As a loved one, it's normal for you to be worried about major or massive hemoptysis. During an emergency situation, it is essential that you act quickly and remain calm. It is very likely that someone in this situation needs your help. Contact emergency services by dialing 911 instead of taking your loved one to the hospital yourself. Responders will be in a position to take care of him properly while ensuring safe and rapid transport to the nearest hospital center.

As psychologist Helen Oxley said in SVB 2010, “regardless of a person's situation, whether hemoptysis is a permanent stress or if it was a traumatic event, it is perfectly normal for it to be accompanied by emotional reactions; our body and mind are designed to respond that way.” If you or a loved one have difficulty dealing with the stress generated by a major episode of hemoptysis; our body and mind are designed to respond that way.” If you or a loved one have difficulty dealing with the stress generated by a major episode of hemoptysis. tysia, do not hesitate to seek help from a health professional.

— Joanie Bernier, Inf., B.SC Cystic Fibrosis Clinic at the McGill University Health Center, Montreal

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