🩸 Distinguishing Hemoptysis from Hematemesis
• Hemoptysis: bright red, frothy, alkaline pH, mixed with sputum, associated with cough
• Hematemesis: dark red/brown, acidic pH, associated with nausea/abdominal pain
• Epistaxis: blood may be swallowed then coughed up
🫁 Most Common Causes
• Respiratory infections (bronchitis, pneumonia — usually mild)
• Foreign body aspiration (organic FB causes inflammation/bleeding)
• Cystic fibrosis → bronchiectasis → most common chronic condition with hemoptysis
• Bronchiectasis from any cause
⚠️ Red Flag & Serious Causes
• Pulmonary-renal syndromes: Goodpasture (anti-GBM), granulomatosis with polyangiitis (Wegener), microscopic polyangiitis
• Pulmonary hemosiderosis: hemosiderin-laden macrophages in BAL, iron deficiency anemia
• Arteriovenous malformation (AVM): hereditary hemorrhagic telangiectasia (Osler-Weber-Rendu)
• Pulmonary hypertension, coagulopathy, trauma
📋 Diagnostic Approach
• CXR initial (may show AVM, contusion, pneumonia, bronchiectasis)
• CT angiography for vascular lesions (AVM)
• Bronchoscopy for active bleeding or suspected FB
• Labs: CBC, coagulation studies, autoimmune markers (ANCA, anti-GBM), urine for RBC/casts
📌 Decision strategy: Most pediatric hemoptysis is mild and self-limited (bronchitis, URI). Any significant hemoptysis or underlying condition (CF, immunodeficiency) → urgent evaluation. Pulmonary-renal syndromes present with hemoptysis + hematuria/nephritis.