Patient handout

Hemoptysis (massive / submassive / mild)

PRODUCTION

1. Your condition

This handout is for hemoptysis (massive / submassive / mild). Your care team identified this based on: coughing blood, blood-streaked sputum, or frank hemoptysis (chest 2018 pmid 31374211).

Other reasons your team may use this plan: massive hemoptysis (>100-200 ml/24 h or any volume causing gas exchange / hemodynamic / airway compromise) (chest 2018 pmid 31374211; larici 2014 pmid 24808437); submassive 30-100 ml/24 h — admit for workup (chest 2018); mild streaking <30 ml/24 h — outpatient workup if low-risk (chest 2018).

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
tranexamic_acid	500-1000 mg IV/PO TID OR 500 mg nebulised TID	IV/PO/inhaled	TID × 5-7 d	Cochrane 2018 PMID 30321510 — supportive in non-massive; small RCTs suggest reduced bleed duration; nebulised route gains traction
vitamin K (phytonadione)	5-10 mg IV/PO	IV/PO	single dose	Reverse warfarin in life-threatening hemoptysis (CHEST 2018)
prothrombin complex concentrate (PCC)	25-50 IU/kg	IV	single dose	Faster reversal than FFP; combine with vitamin K for warfarin (CHEST 2018)
ceftriaxone	1 g IV	IV	daily	IDSA CAP coverage — route to pulm.cap.core.v1
voriconazole	6 mg/kg load × 2 then 4 mg/kg	IV	BID	IDSA aspergillosis 2016 — refractory mycetoma often needs surgery

Plan: Supportive + adjuncts (TXA, reverse anticoag, antibiotic if pneumonic, antifungal if aspergilloma) (CHEST 2018 PMID 31374211 + Cochrane 2018 PMID 30321510)

3. When to call your provider

Contact your care team if any of the following happen:

Volume increase to ≥30 mL/24 h → ED admit
NEW dyspnea / chest pain / fever / weight loss → urgent workup for PE / cancer / infection
Rebleed post-BAE → IR + CT angio (Yu 2010)
Progressive renal dysfunction on vasculitis Rx → rheum/neph route renal.rpgn.core.v1
New focal neuro deficit (HHT paradoxical embolism via AVM) → ED + brain imaging (Faughnan 2020)

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

Hemoptysis >100-200 mL within 24 h OR any volume causing gas-exchange / hemodynamic / airway compromise — functional definition (CHEST 2018 PMID 31374211; Larici 2014 PMID 24808437)(life-threatening)
Hemoptysis 30-100 mL/24 h — admit for inpatient diagnostic workup + therapeutic bronchoscopy (CHEST 2018 PMID 31374211)
Hemoptysis with cavitary consolidation or air-fluid level on CT, fever, leukocytosis, sputum bacterial growth (CHEST 2018)
Cavitary lung lesion + AFB+ sputum or Xpert MTB/RIF+ → confirmed pulmonary TB requires airborne isolation + public health notification (ATS/IDSA 2016 PMID 27516382)
Hemoptysis + pleuritic chest pain + dyspnea ± Wells ≥4 → pulmonary infarct (5-10% of PE present with hemoptysis) — CTPA confirms (CHEST 2018)
Hemoptysis + glomerular hematuria + AKI ± constitutional symptoms (fever, arthralgia, weight loss) → pulmonary-renal vasculitis (GPA / MPA / EGPA / anti-GBM Goodpasture) (ACR 2021 PMID 34235894; RAVE PMID 20647199)(life-threatening)
Hemoptysis + smoker >40 + lung mass on CT — primary lung cancer (squamous, SCLC) or endobronchial metastasis (USPSTF 2021 PMID 33687470)
Hemoptysis with supratherapeutic INR, recent DOAC ingestion, or therapeutic anticoag in patient with underlying lesion (CHEST 2018)
Cavitary lesion with mycetoma (fungus ball on CT — air crescent sign) + hemoptysis (CHEST 2018)
Hemoptysis with telangiectasia (oral, nasal, GI), epistaxis history, family history, pulmonary AVM on CT — hereditary hemorrhagic telangiectasia (Faughnan 2020 PMID 32894695)
Hemoptysis following recent bronchoscopy, PA catheter (pulmonary artery rupture — rare but catastrophic), transthoracic lung biopsy, or chest trauma (CHEST 2018)

5. Follow-up

Pulmonology / IR / thoracic surgery / oncology / ID / rheumatology / genetics (HHT) per pathway (CHEST 2018; Faughnan 2020)

6. Sources

Guideline: CHEST 2018 hemoptysis algorithm (Ittrich/Bockhorn PMID 31374211) + Larici 2014 massive hemoptysis CT (PMID 24808437) + Yu 2010 BAE outcomes (PMID 28703105) + HHT Faughnan 2020 (PMID 32894695) + USPSTF 2021 lung cancer screening (PMID 33687470) + RAVE rituximab in ANCA-vasculitis (PMID 20647199) + Cochrane 2018 TXA (PMID 30321510) + ATS/IDSA TB 2016 (PMID 27516382) + ACR 2021 ANCA-vasculitis (PMID 34235894) + Savale 2007 cryptogenic hemoptysis (PMID 31164971)