It definitely warrants a call to your doctor, but it may not be indicative of serious disease.

By Leah Groth
April 13, 2020
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Many know the key symptoms of COVID-19 by heart (cough, fever, fatigue) as well as some of the more serious or surprising symptoms (shortness of breath, diarrhea). But now, according to recent research and some patient testimonies, a small percentage of COVID-19 cases have also reported coughing up blood.

United States Sen. Amy Klobuchar recently said her husband, John Klobuchar, experienced the scary symptom after he was diagnosed with COVID-19. "John started to feel sick ... and like so many others who have had the disease, he thought it was just a cold," Klobuchar wrote in a Medium post published on March 23. "He kept having a temperature and a bad, bad cough, and when he started coughing up blood he got a test and a chest X-ray and they checked him into a hospital in Virginia."

Another COVID-19 patient, 29-year-old Tarek Soliman, revealed that he had also experienced similar symptoms in an interview with TODAY. "The fever went away on the seventh or eighth day, but by then, the virus had extended to my lungs, and I started developing pneumonia,” he explained. “There was fluid in my lungs, and I was coughing blood. It freaked me out.”

Recent research, too, has found evidence of reports of people coughing up blood with COVID-19: In a February 2020 study published in The Lancet, researchers found that 5% of confirmed cases of COVID-19 (in this study's case, that accounted for two cases out of 39 cases) reported the alarming symptom. Here's what to know bout the rare occurrence—and why doctors say it may not always be indicative of serious disease (though it should be brought to the attention of your healthcare provider).

What exactly does it mean to cough up blood—and how worrisome is it?

Coughing up blood (aka, hemoptysis) is the spitting up of blood or bloody mucus from the lungs and throat, according to the US National Library of Medicine's MedlinePlus resource. It should be noted that blood that comes up with a cough often looks bubbly, since it's mixed with air and mucus. Per MedlinePlus, the blood can appear bright red or rust-colored, and may only show up as streaks in mucus.

Hemoptysis may occur in a variety of diseases, according to Gregory Cosgrove, MD, PFF, chief medical officer for the Pulmonary Fibrosis Foundation. But it's important to note that it's not always indicative of serious disease: “The amount/rate of blood expectorated and the presence of associated symptoms such as breathlessness, low oxygenation (hypoxia), or even changes in blood pressure (hypotension),” all factor into the seriousness of coughing up blood.

According to MedlinePlus, a number of conditions, diseases, and even medical tests and medications can make a person cough up blood. A few include: bronchitis, lung cancer, pneumonia, irritation of the throat from violent coughing, tuberculosis, a bronchoscopy, or even blood-thinning drugs. 

Hemoptysis in general is never a symptom you should ignore (always call your medical provider, even if you cough up blood with no other symptoms), but "typically, patients cough up small flecks of blood intermixed with phlegm," says Dr. Cosgrve. At that point, your doctor may tell you to manage symptoms (i.e., taking cough suppressants) to help minimize heavy coughing, but to keep track of how long you cough up blood and how much blood is mixed with mucus.

In some cases, though, coughing up blood is an emergency: If you're coughing up more than a few teaspoons of blood, and if hemoptysis is accompanied by chest pain, dizziness, fever, lightheadedness, severe shortness of breath, and blood in your urine or stool, it's important you seek medical attention right away. Essentially, according to Dr. Cosgrove, "a simple rule would be that, should anyone cough up blood and have an acute, progressive change in symptoms, they should seek medical care regardless of the amount of blood coughed up."

Why are some COVID-19 patients coughing up blood? 

It should be noted that hemoptysis has only been reported in a small number of COVID-19 patients—and it's not necessarily a main diagnostic symptom of COVID-19. “Typically COVID-19 infections cause cough, sputum production, and shortness of breath," Charles S. Dela Cruz, MD, PhD, a Yale Medicine pulmonologist and associate professor of medicine and microbial pathogenesis, tells Health. "Hemoptysis, which is coughing up blood, is much less common in COVID-19."

Instead, coughing up blood may be more of a secondary symptom—or a complication of symptoms or conditions most commonly caused by COVID-19. Dr. Cosgrove explains that the severity of lung damage from the viral pneumonia is likely the reason why some patients are coughing up blood. Dr. Dela Cruz agrees: “If it does happen, it can mean more severe COVID19 infection or a patient has superimposed bacterial infections," he adds. Again, any type of viral or bacterial pneumonia can cause hemoptysis—not only pneumonia caused by COVID-19.

Of course, coughing up blood at any time can be alarming to both a patient and their family, but it should not be ignored in COVID-19 patients right now. "In the current environment, it should raise concern and be appropriately evaluated, especially if the hemoptysis is associated with shortness of breath,” says Dr. Dela Cruz. 

If you or a family member have tested positive for or have a suspected case of COVID-19 and begin coughing up blood, it's best to call your doctor right away. As a medical professional, they can evaluate your symptoms further and determine any additional treatment, or suggest you come in for an in-person visit, if they believe it's necessary.

The information in this story is accurate as of press time. However, as the situation surrounding COVID-19 continues to evolve, it's possible that some data have changed since publication. While Health is trying to keep our stories as up-to-date as possible, we also encourage readers to stay informed on news and recommendations for their own communities by using the CDCWHO, and their local public health department as resources.

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