Life-threatening haemoptysis

For life-threatening haemoptysis, immediately address symptoms of pain, breathlessness and distress, depending on the patient’s stage of illness:

• if death appears imminent, see Catastrophic terminal events in palliative care for management
• if death does not appear imminent, while considering the patient’s goals of care and suitability for active intervention, consider symptomatic management of acute breathlessness and anxiety.

Use dark towels (eg green, navy blue) to mask the visual impact of blood and minimise distress.

If active intervention is appropriate for life-threatening haemoptysis, seek specialist advice, and arrange transfer to a critical care setting (eg emergency department, intensive care unit). Initial active emergency management includes:

• oxygen therapy, titrated to target oxygen saturation measured by pulse oximetry (SpO₂)
• considering suitability for intubation
• securing intravenous access
• blood tests to determine anaemia and coagulopathy (eg full blood count, international normalised ratio [INR])
• blood group and cross-match
• haemodynamic support
• positioning the patient with the suspected bleeding side down—chest X-ray may help determine which lung is the source of bleeding.

Once the patient is stable, further investigations to determine the cause of the bleeding and subsequent management may include:

• chest computed tomography (CT) with contrast—to identify the bleeding source and suitability for radiological embolisation. See Computed tomography of the chest in the Respiratory guidelines for more information
• bronchoscopy—to identify bleeding source and for management options (eg iced saline lavage, topical vasoconstriction, ablation, bronchial blockade of affected area with a balloon).

Definitive therapies may be considered, such as surgery or radiotherapy for lung cancer, or antimicrobial therapy for tuberculosis or aspergillosis.