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Been spitting blood with no cough. Bronchoscope showed nothing. Why is it getting thicker? Why is she fatigued and dizzy?

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Hello, my 15 year old daughter has been spitting blood up, no cough and don't even have to try to get it to come up, it comes up on it's own! I have taken her to 4 emergency rooms, but they tell me it's not an emergency,.so take her to the PCP,.have him send her to a specialist. We have a Pulmanologist, but they done a bronchoscope and it showed nothing! She didn't have bleeding for 3 weeks prior. It's coming up now with clots and SUPER thick, dark red blood. The time before the last, it was lighter red with tissue in it. I took that to the Childrens hospital to see if they would check it, but they wouldn't! She is very fatigued, chronic dizziness and has confusion. This is NOT coming from the head whatsoever either! Please, any suggestions as to what this may be is greatly appreciated! Thank you and many blessings
Posted Sat, 16 Jun 2012 in Hypertension and Heart Disease
Answered by Dr. Anil Grover 1 hour later
Hi there,

Thank you for writing in. I am cardiologist and try to answer your questions to the best of my knowledge.

Hemoptysis is the technical term for spitting of blood either from lungs or bronchi. You can correct me in the follow up question if there is any wrong presumption I make.

I assume that cardiac and pulmonary system examination before these 3 weeks were normal; yet the blood is dark red colored with clots not frothy(mixed with air) and we have excluded pseudohemoptysis and hematemesis (blood spitting out but originating from stomach).

Frequency of the hemoptysis is more however the quantity is less; therefore emergency room did not consider it an emergency. I hope a chest x-ray has been done and it did not give any clue. Fiberoptic bronchoscopy has been normal.

The commonest causes of hemoptysis in children are Foreign Body, Airway Trauma. Primary Pulmonary Source would include Lung Abscess, Tuberculosis, and Tumor of lung, Lupus and similar disorders. Primary causes related to vascular system include AV fistula, pulmonary embolism, mitral stenosis, pulmonary endometriosis, systemic clotting disorders.
We have normal bronchoscopy and normal clinical examination of chest. A normal Computerized Tomography would have excluded most of the lung related causes.
A cardiac examination with contrast echocardiography will exclude most of cardiovascular causes. If your cardiologist then feels, a pulmonary angiography can be done (a procedure which is not only diagnostic but therapeutic for some conditions).

The goals of management are three fold: bleeding cessation, aspiration prevention, and treatment of the underlying cause.

I do not blame the patient for being fatigued, confused and dizzy. Can you take her to a hospital where there is a cardiologist, pulmonologist, radiologist and gastroenterologist under one roof? She will get well.
With Best wishes. (Do write follow up questions if I have assumed anything wrong).

Dr Anil Grover
Above answer was peer-reviewed by
Follow-up: Been spitting blood with no cough. Bronchoscope showed nothing. Why is it getting thicker? Why is she fatigued and dizzy? 3 hours later
Thank you for the reply Dr. Grover! Well, most of the time there IS quite a bit of air bubbles! I've had my daughter at major hospitals, which they have all of these Dr's under the same roof. I was told they don't have the equipment to do the tests needed, but yet I have had tests performed myself at 2 of them. They said "as long as she's not dying, it's not an emergency", but they don't know what's going on because all they do is a basic chest xray! They will not admit her to run these tests when it starts happening either! Sometimes she spits several times and nothing but blood, and sometimes it's just a few times and stops. However, she is feeling worse as time goes by. It's just not a normal thing to have anyone spitting up blood, let alone a 15 year old teenage girl, which is greatly effecting her quality of life! They have NOT done Tomography, nor anything else, other than what I have mentioned in this email. She's had a CT, but I don't have the reports uploaded. I will work on that and recent labs. One thing it did say was that the heart is upper limits of normal in size, which the Dr didn't remark on. Also during a lung functioning test, her lung capacity had dropped down to 18% of use. She complains of her heart hurting at times as well as her lungs feel "raw". I am at a loss! I just want my child taken care of properly and diagnosed properly, rather than pushing her away and "hemoptysis", which I know is the medical term. I have spoke with a Dr at The National Institutes of Health and he is just appauled at the care in the state we lived in, or should I say the lack of care! This Dr is one of the many that follow my husband per a clinical trial, as well as 2 protocol studies that he's been in for 8 years until this present time. He has Von Hipple Lundou, but we've had genetic testing on both of our daughters and thanks be to The Lord, neither carry the gene, so that isn't a concern. One of the hospitals we've taken her to, my husband was admitted into due to his heart stopping while we were out to dinner. They first took him to the emergency center and when they seen it was much more they could handle, they had him trasported by ambulance to the other hospital to be admitted. However... they are very incompetent! They admitted him, put him in a room and done NO testing until 1.5 days later when they were suppose to have been running tests immediately per Dr's orders. By the fourth day, they had done one ekg, which took 23 hours to read and that's it. They said he couldn't have the stress test for one more day due to nuclear meds, but they didn't do ANY nuclear med studies, period! They were giving him blood thinners without evidence that he needed them, (which he didn't) as well as trying to make him take the study medication that I was told he was to stop immediately, until they knew why his heart stopped. I had the Dr's at NIH calling me for results becauses this hospital would't return call/fax results, until I started to demand answers and have a fit by caliing administration, but now, there's even more going on. Why am I telling you this...I'm just giving you a small glipse of how our healthcare is where we live! I'm sure you can tell my frustration (as if there wasn't enough due to the lack of care for my daughter) in my words. It seems like ALL of the hospitals we've had her at (including childrens) has been just like the one I just explained. Please, I pray you can help her! My family is very ill with many health issues, but I can't get help! We have insurance, granted it is not a major carrier, in fact, it's state assistance because I was disabled at the age of 30. That shouldn't mean the lack of care should be less though, but that sure is the way it feels! I've always been a very hard working woman trying to care for my family, but due to unfortunate circumstances that I had no control over, I have to reach out for medical assistance. I'm so sorry to get on a tangent, but I'm trying to make it a much clearer picture, but I'm sure you already see what's going on. I will jump off of my soapbox now and send this message. I greatly appreciate your time, efforts, willingness and wisdom in trying to help me help me daughter.

Thank you once again Dr. XXXXXXX and many blessings to you : )
Answered by Dr. Anil Grover 58 minutes later

Thank you for your kind words.

But that reminds me the child is sick and justifiably complaining. Please get her admitted if you can. Not necessarily in emergency but in pediatric ward.

Establishing a diagnosis will not take long, some investigations will be decided by treating doctors and visiting consultants. Within a matter of hours treatment will be started.

I appreciate blessings sent to me; your sick daughter is my prayers to Almighty.

Knowing the system there you will be able to find a solution but keep your cool.

Best Wishes.

Anil Grover
Above answer was peer-reviewed by
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