From the Guidelines
Hemoptysis is classified into three degrees: mild, moderate, and severe or massive, based on the volume of blood expectorated, with management and mortality risk varying significantly across these categories. The degrees of hemoptysis are defined as follows:
- Mild hemoptysis: less than 20 mL of blood per 24 hours, characterized by blood-streaked sputum
- Moderate hemoptysis: 20-200 mL per 24 hours, presenting as frank blood in the sputum
- Severe or massive hemoptysis: exceeds 200 mL per 24 hours, though some definitions use thresholds of 300-600 mL, and is often defined as hemoptysis that can threaten life, placing the patient at high risk for asphyxiation or exsanguination 1. The management of hemoptysis depends on the severity, with mild cases requiring observation and treatment of the underlying cause, moderate cases needing closer monitoring, and severe cases demanding immediate hospitalization, airway protection, and possibly interventional procedures like bronchial artery embolization or surgery 1. Key factors in determining the severity of hemoptysis include the volume of blood expectorated, the rate of hemoptysis, and the presence of concomitant hypotension, with morbidity and mortality more closely associated with the rate of hemoptysis rather than the quantity of hemoptysis 1. Accurate quantification of hemoptysis can be challenging in clinical practice, so healthcare providers often rely on patient descriptions and clinical assessment to determine severity and appropriate management. The degree of hemoptysis is crucial for clinical decision-making, as it correlates with mortality risk, with massive hemoptysis carrying a high mortality rate if not promptly addressed.
From the Research
Degrees of Hemoptysis
The degrees of hemoptysis can be classified based on the quantity of expectorated blood. The following are the different degrees of hemoptysis:
- Minor: less than 30 mL of hemoptysis 2
- Moderate to severe (major): 30 to 300 mL of hemoptysis 2
- Massive: more than 300 to 400 mL in 24 hours 2 Hemoptysis can also be categorized as mild or massive, with mild hemoptysis comprising more than 90% of cases and having a good prognosis, whereas massive hemoptysis has a high mortality rate 3
Classification and Evaluation
The evaluation of hemoptysis includes determining the severity of bleeding and stability of the patient, and may require bronchoscopy for airway protection 3. The initial evaluation also includes a chest radiograph, although it has limited sensitivity for determining the site and etiology of the bleeding 3, 4. Computed tomography and computed tomography angiography of the chest with intravenous contrast are the preferred modalities to determine the etiology of bleeding 3, 4.
Management and Treatment
The management of hemoptysis begins with an initial assessment of gas exchange and hemodynamic stability, followed by an identification of the cause by means of fiberoptic bronchoscopy, and chest imaging studies to attain cessation of bleeding and to prevent future recurrence 5. Bronchial arterial embolization is used to treat massive hemoptysis, particularly when an involved artery is noted on computed tomography angiography 3, 2, 4. Surgery is reserved for patients whose medical treatment and embolization are not effective 3, 4