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Haemoptysis

Streaking haemoptysis

This is relatively common in older children with CF and in the vast majority is blood streaking in the sputum. This results from damage to inflamed airway mucosa and is most likely to occur during an infective exacerbation and so this should nearly always mean starting a course of antibiotics - iv or oral depending of the severity of the exacerbation. Oral tranexamic acid may be useful in children with recurrent bleeds.

Massive haemoptysis

A much smaller proportion of CF patients experience massive haemoptysis (about 5% lifetime risk) with expectoration of more that 250ml of blood in a 24 hour period. This more substantial bleeding is from small bronchial arteries which have eroded into the airway. It can be fatal and should therefore be evaluated quickly. Some CF patients can also bleed from oesophageal varices and it is important to distinguish between these 2 conditions.

What to do

Admit to the ward. Check clotting status, and platelet count (some CF patients have hypersplenism) and order 2 units of blood. If the clotting is deranged give iv vitamin k. Start iv antibiotics and bed rest. Percussion-based physiotherapy can precipitate a bleed. Changing to PEP mask or flutter/acapello-based treatment until bleeding has stopped for 12 hours may help avoid this. It is important that some form of physiotherapy is maintained.Transfuse as indicated clinically. Consider bronchial artery embolisation. Oral tranexamic acid may be useful in in children with recurrent bleeds.