Guidelines for the management of

Haemoptysis:
Date Produced:

November 2003-11-06

Next revision:

August 2018

This guideline is applicable to all patients seen on the

EAU/ESSU with haemoptysis.
Local Contact: Dr Jane Dewar, Consultant Physician

This guideline has been registered with the Trust.

However, clinical guidelines are guidelines only. The
interpretation and application of clinical guidelines will
remain the responsibility of the individual clinician. If in
doubt, contact a senior colleagu e or expert. Caution is
advised when using guidelines after the review date.

Guidelines for the management of haemoptysis:

Large Haemoptysis: > 150mls/ airway compromise
Is the bleed a terminal event?
Eg. Is the patient in the terminal stage of
lung cancer/chronic lung disease, where
attempts at resuscitation would be futile.

No

Yes

Initial Management:

Airway
Breathing
Circulation
Suction
If the patient cannot maintain their
airway, intubation .
Lie the patient on the same side as
lesion/Abnormality on CXR
IV access & Volume re placement
Bloods for Cross-match, FBC and
clotting.
Contact Respiratory Physician and
thoracic surgeons

Further Assessment
CT thorax for anatomical localisation
Liaise with radiology and thoracic
surgeons to determine best
management: bronchial arterial
embolisation/ surgery/ bronchoscopy
(rigid or flexible) to identify source of
bleeding
Assume infection in patients with
CF/Bronchiectasis and treat
aggressively with antibiotics.

Palliation
Palliate the patient
3-5mg midazolam and 5mg
diamorphine.
Suction

Guidelines for the management of haemoptysis:

The causes of haemoptysis are diverse, and as such management will differ
according to the exact pathology suspected. The following are therefore
guidelines, and will need to be tailored to individual patients.

only

Minor Haemoptysis: <150mls

Minor Haemoptysis

Isolated

CXR Normal
Age<40yrs
Life-long non-smoker

Recurrent

Refer Respiratory
Medicine-urgent
OPA if well enough
to go home-Resp.
SPR on call for
referrals will
organise. If not,
transfer Sou/Flem
Investigate

No to any

Yes
Family history of Lung
Cancer
Previous history of cancers
involving lung, head, neck or
breast
Previous exposure to
carcinogens eg. Asbestos
and radon gas.

Yes to any

No

Exclude other pathologies if

suspected from history eg. PE

No further action required if isolated

haemoptysis of unknown aetiology.

Patients must be told to consult their

GP if they have a further episode, as
this will require further investigation.

Refer Respiratory
Medicine (as above).
Investigate: CT thorax
and bronchoscopy