2. WHERE IS IT FROM?
Not always the spitting of blood will mean that bleeding
has occurred in the lungs. Because of the seriuosness that pulmonary hemorrhage
implies, the lungs as the source of the bleed has to be well established.
By history, try to establish whether the blood was vomited
or coughed. Have the parents and the patient describe the blood. Blood coming
from the GI tract will have different characteristics than that coming from
the lungs, and different symptoms may be related to episode:
GI |
Respiratory tract |
| Dark red or brown | Bright red |
| In clumps | Foamy, runny |
| Mixed with food | Mixed with mucus |
| acidic pH | alkaline pH |
| Stomachache, abdominal discomfort | Chest pain, localized warmth or gurgling over chest |
| Nausea, retching before/after episode | Persistent cough |
Determine if there is any pre-existing medical condition.
Currently the most common underlying condition associated with hemoptysis
in children is CF,
but also children with congenital heart disease, sickle-cell anemia and
autoimmune disorders can present with hemoptysis.
Physical exam can also be revealing. Start with a good
HEENT exam, bleeding from the nose, nasopharynx, tonsils, tongue, gums,
or oropharynx can be easily identified. Most importantly, do a quick assessment
of vital signs, respiratory status (is distress present or not?, is oxygenation
adequate?) and hemodynamic status. Lung exam may be non-contributory, but
decreased breath sounds, crackles, ronchi or wheezes can be heard diffusely
or localized.
At presentation, just a complete blood count and a chest
radiogram will be enough to help establish the seriousness of the problem
(along with the history and physical exam findings) and the need for further
intervention and investigations.
Click here to go to section 3:
Pulmonary Hemorrhage in the Neonatal Period