Bloody Phlegm: Causes, Associated Diseases, Serious Symptoms, Diagnosis and Treatment

Also known as sputum, it is a mixture of saliva and mucus that is released from the lungs when you cough.

Bloody sputum comes from somewhere within the body, either along the respiratory tract or the digestive system .

Sometimes blood-tinged sputum is a symptom of a serious medical condition.

When blood is cough with little or no sputum, immediate medical attention should be sought.

Coughing up blood can be quite a confusing and alarming symptom and can simply be caused by bleeding from the mouth or nasal area.

The blood from these areas mixes with the mucosa or phlegm that exits the respiratory tract, giving the appearance that the blood is part of the phlegm matter, without necessarily revealing the origin.

Oddly enough, it is also not uncommon for blood-tinged phlegm to be found in people who also suffer from certain types of gastrointestinal problems, even though it appears to be related to a cough or respiratory illness.


There are some characteristics of bloody phlegm that can make it easier to tell where it comes from.

When there is bloody mucus, signs of disease, other health conditions, and the site of bleeding include color and consistency.

When blood comes from the lungs, it can take on a bubbly or airy appearance.

This is because the combination of mucus mixed with blood and air can create a fluffier consistency.

A bloody mucus can show streaks that are very shiny with the characteristic red color, if not completely soiled, and also a deeper rust color.

There are many diseases that can produce blood in phlegm.

Most bloody phlegm is related to respiratory conditions, lung diseases, or a related condition.

The most common causes of bloody phlegm include common respiratory tract diseases:

  • Prolonged and severe cough that irritates the respiratory tract.
  • Nosebleeds
  • Laryngitis.
  • Pulmonary aspiration or the presence of a foreign material in the lung.
  • Take blood thinners.
  • Trauma to the respiratory system.
  • Respiratory infections or inhalation of a foreign object are the probable causes of blood-tinged sputum in children.

Associated diseases

There are diseases that cause the appearance of blood in phlegm such as:


Emphysema literally refers to the dilation of the alveoli or the direct destruction of the walls of these delicate air sacs found in the lungs.

As time passes, the damage becomes more and more severe, leading to a noticeable decrease in the ability to breathe.

Emphysema is one of the most common health conditions known to produce signs and symptoms of chronic obstructive lung diseases.

Most symptoms of emphysema are related to shortness of breath.

Aside from blood in phlegm, which often occurs as a later symptom of the condition, other symptoms of emphysema include a decrease in mental alertness, gray or blue nails, rapid heartbeat, and extreme shortness of breath.

Mitral valve stenosis

Essentially, the condition refers to the narrowing of the heart’s mitral valve, which in turn can block blood flow.

One of the most common causes of mitral valve stenosis is rheumatic fever.

Symptoms of mitral stenosis vary, but most often include swollen ankles, heart palpitations, shortness of breath, and a tendency to develop respiratory diseases more frequently, causing blood in the phlegm.


Pneumonia most commonly refers to an acquired condition characterized by an infection of the lungs.

It can be caused by fungi, bacteria, or viruses and can be contracted by inhaling or coming into contact with some of the germs that cause it.

Symptoms of pneumonia vary from person to person based on several factors, such as general health and the severity and duration of the illness.

Most commonly, it has symptoms such as fever, chills and tremors, shortness of breath, and a greenish color or blood in the phlegm that accompanies the cough.

Other less common pneumonia symptoms or those associated with more severe cases of the condition include chest pain, headaches, and confusion.

Lung cancer

People who smoke are at higher risk of developing lung cancer, although chemical exposure, alcohol use, and the presence of pre-existing conditions such as emphysema can also increase the likelihood of developing one of the many types of lung cancer.

Symptoms of lung cancer are usually not present until the disease has worsened.

Some of the most characteristic symptoms include a cough that is worse and persistent, accompanied by small amounts of blood in the phlegm when coughing.

Pulmonary embolism

When a clot of blood, air, fat, or even tumor cells causes a blockage in an artery inside the lungs, the condition is known as a pulmonary embolism.

While blood clots are among the most common causes of pulmonary embolism, parasites and even amniotic fluid have been associated with the development of embolisms.

Pulmonary embolisms are the result of deep vein thrombosis, where a blood clot that forms in the lower legs travels upward to lodge in the arteries of the lungs.

Usually coughing that may contain blood in phlegm and mucus, symptoms of a pulmonary embolism include an increased heart rate, increased breathing rate, and shortness of breath.

Sometimes dizziness, sweating, and blue skin may appear less often.

Pulmonary tuberculosis

Although pulmonary tuberculosis may seem very similar to pneumonia, it is different in many ways.

Lung infection is specifically related to a type of bacteria, known as M. tuberculosis.

This bacteria can lie dormant for long periods of time, only becoming active days or even weeks after initial contact with the bacteria.

Babies, the elderly, and those with compromised immune systems are more likely to develop severe cases of pulmonary tuberculosis.

Weight loss, fever, fatigue, sweating, chest pain, wheezing, and shortness of breath are some of the most common symptoms of the disease.

A mucus-laden cough that contains blood in the phlegm is a symptom of pulmonary tuberculosis.


Bronchitis is characterized by inflammation and swelling of the airways leading to the lungs, it occurs in two forms, acute (short periods of time) or chronic (occurs frequently for longer periods of time).

While both forms of the disease are known to cause coughing and mucus production, chronic obstructive bronchitis is even more serious and is associated with blood that contains phlegm or mucus.

Apart from this telltale symptom, there is also fever, fatigue and wheezing, pain and discomfort in the chest.

Systemic lupus erythematosus

The relationship of systemic lupus erythematosus to bloody phlegm can seem somewhat confusing.

However, the autoimmune condition actually has a wide range of symptoms that span almost every physiological system in the body, including the respiratory tract.

Symptoms of the predominantly female condition include fever and fatigue, hair loss, mouth sores, nervous system symptoms, skin symptoms, and arrhythmia.

But also, there is blood in the phlegm.

Pulmonary edema

When fluid builds up in the alveoli that are supposed to contain air in the lungs, the result is pulmonary edema and is commonly associated with congestive heart failure .

The condition is characterized by the inability of the heart to pump blood throughout the body as it should, which can cause fluid to flow into the alveolar spaces in the lungs that are normally supposed to fill with air.

In addition to anxiety, restlessness, and decreased alertness, other symptoms of pulmonary edema include sweating, pale skin, wheezing or gurgling noises when breathing, and blood in phlegm.

Cystic fibrosis

Cystic fibrosis is an inherited disease characterized by the formation and accumulation of mucus in the gastrointestinal tract, lungs, and elsewhere.

Mucus is often thick and sticky and, although very common, it is considered a serious and life-threatening condition.

Because cystic fibrosis can affect so many parts of the body, symptoms vary widely.

When the gastrointestinal tract is affected, abdominal pain and nausea can persist.

When the respiratory system is affected, congestion and coughing up blood can occur. However, a complete inventory of symptoms will vary greatly from person to person.

Severe symptoms

  • Coughing up phlegm with more blood and very little sputum.
  • Difficulty breathing.
  • Soft spot.
  • Dizziness.
  • Excessive perspiration
  • Fast heart rate
  • Unexplained weight loss
  • Fatigue.
  • Chest pain.
  • Presence of blood in urine or stool.

These symptoms are associated with serious medical conditions.


The diagnosis is made based on the medical history and the respective physical examination. Imaging studies such as:

  • Chest X-rays, to look at the airways.
  • Chest CT scan to get a clearer image of soft tissues.
  • Bronchoscopy, to detect the presence of obstructions or abnormalities in the airways.

A blood test may be ordered and in case of observing any kind of abnormality in the structure of the lung and airways in general, a biopsy may be ordered.


Treatment of bloody phlegm will depend on the underlying disease causing it.

Treatments for bloody phlegm may include:

  • Antibiotics for infections such as bacterial pneumonia and tuberculosis.
  • Antivirals, to reduce the duration or severity of a virus.
  • Antitussives to calm prolonged coughs, on medical advice as they can cause obstructions in the respiratory tract, prolonging and worsening the infection.
  • Drink enough water, to help thin and eliminate phlegm.
  • Surgery in cases where bloody phlegm is caused by a tumor or a blood clot.