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Health condition

Haemoptysis, every episode needs an explanation - and often a CT.

Coughing up blood is never normal. Most episodes have a treatable cause, but the volume, the setting and the risk factors decide how quickly you need to be seen.

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A radiographer guides a patient onto the bed of an advanced 3 Tesla MRI scanner in a London imaging suite

Why trust this guide

  • 01

    Editorial team

    Written by our editorial team from the UK sources listed on each page.

  • 02

    Sourced from guidance

    Checked against BTS, NICE NG12 (suspected cancer) and NG33 (TB) plus peer-reviewed respiratory sources.

  • 03

    Current for 2026

    Reflects modern UK respiratory practice including CT chest, flexible bronchoscopy and bronchial artery embolisation.

Key facts

Haemoptysis at a glance.

The essentials, in plain English - what it is, why it happens and how UK respiratory teams sort it out.

  • What it is

    Coughing up blood or blood-stained sputum from the airways below the larynx. Any amount deserves investigation.

  • Massive haemoptysis

    More than 200 ml in 24 hours, or any volume that threatens the airway. An emergency needing hospital care.

  • Commonest causes

    Infection (bronchitis, pneumonia, TB, bronchiectasis), lung cancer, pulmonary embolism and iatrogenic bleeding on anticoagulants.

  • First test

    Chest X-ray at first contact, then a CT chest, which is the gold standard for finding the source.

  • Cancer pathway

    Smokers over 40 with haemoptysis meet the NICE NG12 urgent two-week referral criteria for suspected lung cancer.

  • Definitive control

    Bronchial artery embolisation, bronchoscopic haemostasis and surgical resection stop bleeding once the source is known.

Why this guide matters

A symptom that always earns a work-up.

Haemoptysis is common in UK primary and secondary care. Most causes are treatable, but three principles shape how it is handled.

  • Every episode needs a cause

    Even a single streak of blood is a symptom, not a diagnosis. Blood tests, a CXR and usually a CT chest are the starting point.

  • Massive haemoptysis is airway-first

    The lethal risk is drowning in blood, not exsanguination. Airway protection, positioning and specialist care come before anything else.

  • The cancer clock starts on day one

    Any smoker over 40 with new haemoptysis meets the NICE NG12 two-week urgent pathway for suspected lung cancer.

How the diagnosis is made

From first cough to a clear source.

The steps a UK GP, emergency department or respiratory team will normally follow - so you know what to expect.

  1. 01

    Assessing

    Confirm the source

    Distinguish airway blood from haematemesis (upper GI) and epistaxis (nose). Frothy, bright red and alkaline blood points to the lungs.

  2. 02

    Assessing

    Volume and risk stratification

    Estimate volume, look at vital signs and screen for smoking, TB exposure, travel, occupation, anticoagulants and known lung disease.

  3. 03

    Assessing

    Focused examination

    Respiratory, cardiovascular and ENT exam to rule out pseudohaemoptysis, epistaxis and haematemesis at the bedside.

  4. 04

    Confirming

    Baseline bloods

    FBC, clotting, U&Es, LFTs, inflammatory markers, D-dimer and, where clinically indicated, ANCA and anti-GBM antibodies.

  5. 05

    Confirming

    Chest X-ray and CT chest

    CXR first, then a CT chest, which is the gold standard for cancer, bronchiectasis, PE, cavitation and vascular malformation.

  6. 06

    Localising

    Flexible bronchoscopy

    A respiratory-led look inside the airways to localise the bleeding source, sample it and, where needed, stop it.

  7. 07

    Localising

    Cardiac and vascular work-up

    ECG and echocardiogram where mitral stenosis, pulmonary hypertension or a shunt lesion is suspected.

Typical timeline: first assessment to a working diagnosis within days, sometimes hours.

Symptoms

What haemoptysis looks like.

From a streak in the sputum to frank red blood - and the associated features that change how urgently you need to be seen.

  • Streaks of blood in sputum

    Small volume blood-streaked sputum with a productive cough often points to acute bronchitis or pneumonia.

  • Frank red blood

    Bright red, frothy, alkaline blood in larger volumes suggests a bronchial or pulmonary arterial source.

  • Purulent blood-stained sputum

    Blood mixed with green or yellow sputum is common in bronchiectasis, lung abscess and cavitating infection.

  • Weight loss and night sweats

    Systemic features raise concern for tuberculosis or malignancy and warrant urgent imaging and specialist review.

  • Pleuritic chest pain and dyspnoea

    A sudden pleuritic pain and breathlessness with haemoptysis is pulmonary embolism until proven otherwise.

  • Haemoptysis with haematuria

    Blood in the urine alongside haemoptysis suggests a pulmonary-renal syndrome such as Goodpasture or GPA.

  • On anticoagulants or antiplatelets

    Iatrogenic bleeding on warfarin, DOACs or dual antiplatelet therapy is a common contributor that still needs a source.

  • Red flag - massive haemoptysis

    More than 200 ml in 24 hours, or any volume compromising the airway, is a medical emergency needing resuscitation.

Treatment

How haemoptysis is treated in the UK.

The rule is simple - treat the cause and, when the bleeding is heavy, stop it directly with embolisation, bronchoscopy or surgery.

  • Treat the underlying cause

    Antibiotics for infection, TB therapy per NICE NG33, anticoagulation for PE and immunosuppression for vasculitis all address the root problem.

  • Airway protection and resus

    For massive haemoptysis - resuscitate, protect the airway, position the bleeding side down, correct coagulopathy and admit for specialist care.

  • Flexible bronchoscopy

    A specialist respiratory procedure to localise the bleed, sample the airway and apply bronchoscopic haemostasis or tamponade where indicated.

  • Bronchial artery embolisation

    An interventional radiology procedure that occludes the bleeding artery. First-line for massive or persistent haemoptysis in most UK centres.

  • Surgical resection

    Considered for localised cancer, arteriovenous malformation, aspergilloma or persistent bleeding that has failed embolisation.

  • Anticoagulant and antiplatelet review

    Where safe, stop or reverse anticoagulation and review antiplatelets with the prescribing team before restarting.

  • Immunosuppression for vasculitis

    Steroids, rituximab and plasma exchange for anti-GBM disease and ANCA-associated vasculitis, led by respiratory and renal teams.

  • MDT respiratory care

    Complex haemoptysis is managed by a multidisciplinary team of respiratory, oncology, interventional radiology, infectious diseases and thoracic surgery.

What this guide is based on

The sources behind every claim on this page.

UK national guidance and respiratory society standards, current at the time of last review.

Key references

Guidelines and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

Your GP or respiratory team knows your history and can tell you which parts apply to you. If you are coughing up more than a few streaks of blood, get seen urgently.

  • British Thoracic Society (BTS). Guidelines on the assessment and management of haemoptysis.

  • NICE. Suspected cancer: recognition and referral (NG12) - lung cancer two-week wait pathway.

  • NICE. Tuberculosis (NG33) - diagnosis and management.

  • Royal College of Radiologists. Standards for bronchial artery embolisation.

  • Asthma + Lung UK. Patient information on coughing up blood.

Red flags

When haemoptysis is an emergency.

Some patterns need urgent, sometimes same-day assessment. If any of the below apply to you, do not wait.

  • Massive haemoptysis

    More than 200 ml in 24 hours, or any volume threatening the airway. Call 999 and treat as an airway emergency.

  • Haemoptysis with breathlessness

    Sudden pleuritic pain, tachycardia and desaturation with haemoptysis is pulmonary embolism until proven otherwise.

  • Smoker over 40 with new haemoptysis

    Meets the NICE NG12 criteria for an urgent two-week referral for suspected lung cancer, even if the volume is small.

  • Weight loss, fever and night sweats

    Systemic features with haemoptysis raise concern for tuberculosis or malignancy - urgent imaging and specialist review.

  • Haemoptysis with haematuria or rash

    A pulmonary-renal picture suggests anti-GBM disease or ANCA-associated vasculitis and needs urgent specialist input.

  • Haemoptysis on anticoagulation

    Any haemoptysis on warfarin, a DOAC or dual antiplatelet therapy needs prompt review, reversal planning and a source hunt.

  • Haemoptysis after chest trauma

    Blunt or penetrating chest injury with haemoptysis needs urgent trauma assessment and CT imaging.

  • Recurrent or unexplained haemoptysis

    Even small recurrent bleeds without a clear cause deserve a CT chest and a respiratory opinion.

  • Known bronchiectasis with fresh bleed

    A change from usual sputum to fresh blood in bronchiectasis often signals an exacerbation or new infection.

Living with it

A serious symptom, handled well by modern respiratory care.

Four things that make the biggest difference - acting fast, stopping smoking, sharing a full medication list and completing your follow-up.

A quiet reminder

Even small bleeds deserve a proper look.

A little blood today can be the first sign of something bigger. Cancer, TB and vasculitis often announce themselves quietly.

  1. 01 Act fast

    Get seen the same day

    Any new haemoptysis needs a same-day GP or emergency assessment. Massive bleeding is a 999 call.

  2. 02 Stop smoking

    Quitting changes the odds

    Smoking is the strongest modifiable risk factor for lung cancer and worsens almost every other cause of haemoptysis.

  3. 03 Medications

    Bring your list

    Anticoagulants, antiplatelets and inhaled therapies matter - a full medication review is part of every assessment.

  4. 04 Follow-up

    See the plan through

    Even after bleeding stops, follow up matters. Cancer, TB and vasculitis can present with small, self-limiting bleeds first.

Frequently asked

Everything we get asked about haemoptysis.

Quick answers on causes, urgency, investigations and how bleeding is stopped.

  • What is haemoptysis?

    Haemoptysis is coughing up blood or blood-stained sputum from the airways below the larynx. It ranges from streaks in the sputum to massive, life-threatening bleeding of more than 200 ml in 24 hours. Any amount deserves investigation to find the cause.

  • How do I know it is not blood from my stomach or nose?

    Coughed-up blood is usually bright red, frothy and alkaline and comes with a cough. Blood from the stomach (haematemesis) is often dark, mixed with food and comes with vomiting. Nosebleeds (epistaxis) start in the nose and drip backwards. Your clinician will confirm the source with a careful history and examination.

  • What are the commonest causes in the UK?

    Infection (acute bronchitis, pneumonia, tuberculosis and bronchiectasis), lung cancer, pulmonary embolism and iatrogenic bleeding on anticoagulants account for most cases. Vasculitis, cardiac causes and vascular malformations are less common but important.

  • When is haemoptysis an emergency?

    Massive haemoptysis - more than 200 ml in 24 hours or any volume that threatens the airway - is a medical emergency. Call 999. Warning signs include breathlessness, dizziness, low blood pressure, chest pain and coughing up large volumes of frank red blood.

  • Which tests will I need?

    Blood tests, a chest X-ray and, in almost all cases, a CT chest, which is the gold standard. Many patients also need a flexible bronchoscopy to localise the source. Additional tests such as ECG, echocardiogram and vasculitis screen depend on the suspected cause.

  • How is severe haemoptysis stopped?

    The airway is protected, blood loss is replaced, clotting is corrected and the bleeding side is positioned down. Bronchial artery embolisation, a specialist interventional radiology procedure, occludes the bleeding artery and is first-line for most massive bleeds. Bronchoscopic haemostasis and surgery are also used.

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