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

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

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

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

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

Coughing up blood can be quite a confusing and alarming symptom 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, indicating 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 in people who suffer from some gastrointestinal issues, even though it appears to be related to 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 be bubbly or airy.

This is because mucus combined 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 wholly soiled, and a deeper rust color.

Many diseases 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 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

Some diseases cause the appearance of blood in phlegm, such as:


Emphysema 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 can block blood flow.

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

Symptoms of mitral stenosis vary but 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.

It commonly 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. However, chemical exposure, alcohol use, and 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 worse and persistent cough, 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 result from 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 related explicitly to bacteria known as M. tuberculosis.

This bacteria can lie dormant for long periods, only becoming active days or 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) or chronic (frequently occurs for more extended periods of time).

While both forms of the disease cause coughing and mucus production, chronic obstructive bronchitis is even more severe and associated with blood containing phlegm or mucus.

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

Systemic lupus erythematosus

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

However, the autoimmune condition 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 which 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 generally 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 severe and life-threatening condition.

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

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

Congestion and coughing up blood can occur when the respiratory system is affected. However, a complete inventory of symptoms will vary significantly 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 severe 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 if any abnormality is observed in the structure of the lung and airways in general, a biopsy may be requested.


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 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 a tumor or a blood clot causes bloody phlegm.