Why COVID-19 May Cause Some People to Cough Up Blood - Health.com

Although rare, coughing up blood-tinged mucus if you have COVID-19 is not necessarily abnormal. Coughing is one of the most common COVID-19 symptoms, and you may notice blood if you are coughing too forcibly. Other times, coughing up blood may signal viral pneumonia, a complication of COVID-19.

Coughing up small amounts of blood is usually not serious, but you'll still want to consult a healthcare provider. They may advise taking cough suppressants to reduce how much or violently you are coughing.

Here's what to know about the rare occurrence, why healthcare providers say it may not always indicate severe disease, and when to consult a healthcare provider.

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Coughing up blood, or hemoptysis, is the spitting up of blood or bloody mucus from the throat and lungs. Blood that comes up with a cough often looks bubbly since it's mixed with air and mucus. The blood can appear bright red or rust-colored and may only show up as streaks in your mucus.

Factors that affect the severity of coughing up blood include "[t]he amount and rate of blood expectorated and the presence of associated symptoms such as breathlessness, low oxygenation, or even changes in blood pressure," Gregory Cosgrove, MD, vice president of clinical development at Pliant Therapeutics, told Health. 

Coughing Up Blood from the Throat

Coughing up blood from your through typically happens if you cough too much or violently. Coughing is one of the most common COVID-19 symptoms. Your throat may become irritated if you cough too forcibly, bringing up small amounts of blood.

Coughing Up Blood From the Lungs

Coughing up blood from your lungs may happen if you have an illness or injury that involves the lungs. For example, a bronchoscopy may cause injury to the lungs. A bronchoscopy is a diagnostic test that healthcare providers use to examine your airways.

Sometimes, coughing up blood may occur if there's a blood clot in your lungs. Blood thinners, which prevent blood clots, may cause you to cough up blood.

Coughing up blood may occur with various illnesses that involve the lungs, including:

• Bronchiectasis: This disease causes damage to and widens the large airways in your lungs.
• Bronchitis: This involves inflamed, swollen tissue in your lungs, which narrows your airways.
• Cystic fibrosis: This disease causes sticky, thick mucus to build up in your lungs, among other areas.
• Lung cancer: A long-term cough that worsens and brings up blood may signal lung cancer. Other lung cancer symptoms include frequent lung infections and unexplained weight loss.
• Lung infections: Pneumonia causes inflammation and irritation in your lungs, which may cause you to cough up blood.
• Lupus: Your immune system mistakenly targets and attacks your healthy cells. Lupus can affect many body parts, including your lungs.
• Pulmonary aspiration: This happens if you breathe food or other materials into your lungs.
• Pulmonary edema: This causes excess fluid to build up in your lungs.
• Tuberculosis: This bacterial infection involves the lungs.
• Vasculitis: You may cough up blood if the blood vessels in your lungs become inflamed.

Coughing up blood has only been reported in a few people with COVID-19. Research has found that the overall prevalence of coughing up blood among people with COVID-19 is 3.3%.

"Typically, COVID-19 infections cause cough, sputum production, and shortness of breath," Charles Dela Cruz, MD, a pulmonologist and associate professor of medicine at the Yale School of Medicine, told Health. "Hemoptysis, which is coughing up blood, is much less common in COVID-19."

Coughing up blood has appeared in people who previously had COVID-19. A study published in 2022 detailed a person who sought emergency care for a moderate case of coughing up blood. The person was healthy other than testing positive for COVID-19 two months prior. The researchers hypothesized that coughing up blood may be a complication of COVID-19.

Coughing up blood may happen with or without mucus, which may appear blood-tinged. Mucus that drips back down your throat, or post-nasal drip, often causes coughing.

Research has found that some people with COVID-19 have a productive cough, or coughing that produces mucus. Your mucus may be bloody.

Sometimes, coughing up mucus from your throat is a sign of viral pneumonia. Viruses—including SARS-CoV-2, the virus that causes COVID-19—may infect your lungs, which causes pneumonia. The severity of lung damage from viral pneumonia is likely why some people cough up blood, said Dr. Cosgrove. 

Viral pneumonia raises the risk of bacterial pneumonia. Blood-tinged mucus from your nose may indicate a bacterial infection.

"If [coughing up blood] does happen, it can mean more severe COVID-19 infection or a patient has superimposed bacterial infections," said Dr. Dela Cruz. 

Consult a healthcare provider if you have confirmed or suspected COVID-19 and start coughing up blood.

They can evaluate your symptoms further and figure out the proper treatment. For example, a healthcare provider may tell you to use cough suppressants to minimize heavy coughing. They might ask that you track how long you cough up blood and how much blood is mixed with mucus.

In some cases, coughing up blood is an emergency. Seek medical attention right away if you are coughing up more than a few teaspoons of blood.

Other warning signs and symptoms include:

• Blood in your stool or urine
• Chest pain
• Dizziness
• Fever
• Lightheadedness
• Severe shortness of breath

Essentially, "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," said Dr. Cosgrove.

If you have COVID-19, coughing up blood may be a sign that you are coughing too much or violently. Other times, coughing up blood may signal viral pneumonia.

Consult a healthcare provider right away if you are coughing up a lot of blood, or more than a few teaspoons. Seek immediate medical care if you are coughing up blood and develop severe chest pain or shortness of breath.

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 CDC, WHO, and their local public health department as resources.

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