Can Tuberculosis Cause Coughing Up Blood?

Understanding the Link Between Tuberculosis and Hemoptysis

Tuberculosis (TB) is a serious infectious disease that primarily affects the lungs, and one of its notable symptoms is hemoptysis—coughing up blood. This condition is particularly common in patients with cavitary pulmonary tuberculosis, where lung tissue has been destroyed, forming cavities. These cavities often develop as a result of extensive necrosis caused by the Mycobacterium tuberculosis bacteria. As the infection progresses, it can erode the walls of nearby blood vessels, leading to bleeding into the airways.

Why Does TB Lead to Bleeding?

The primary cause of hemoptysis in TB patients is vascular damage due to chronic inflammation and tissue destruction. In cavitary TB, the breakdown of lung parenchyma exposes pulmonary blood vessels, making them vulnerable to rupture. The amount of blood expelled can vary significantly—from mild streaks in sputum to larger clots. In severe cases, massive hemoptysis may occur, which involves the sudden release of over 200–300 mL of blood within 24 hours, posing an immediate threat to life.

Long-Term Risks Even After Recovery

Even after successful treatment and apparent recovery, individuals previously infected with TB remain at risk for recurrent bleeding. Post-tuberculosis complications such as bronchiectasis—a permanent widening and scarring of the airways—can develop in healed areas of the lung. These structural changes create pockets where mucus accumulates, fostering bacterial growth and repeated infections, both of which can trigger episodes of hemoptysis years after the original infection has been eradicated.

Fibrotic Changes and Sudden Bleeding Episodes

In some recovered patients, fibrosis, calcification, or hardening of lung tissue occurs as part of the healing process. While these changes indicate inactive disease, they are not without risks. Intense coughing can cause mechanical stress on these rigid, scarred regions, potentially tearing fragile blood vessels embedded within the fibrotic tissue. This can lead to unexpected and sometimes severe episodes of bleeding, underscoring the importance of ongoing respiratory monitoring even in clinically cured individuals.

Potential Complications of Severe Hemoptysis

Massive hemoptysis is considered a medical emergency due to its high mortality rate. When large volumes of blood fill the tracheobronchial tree, it can obstruct airflow, leading to asphyxiation or acute lung collapse (atelectasis). Additionally, significant blood loss may result in hypovolemic shock, a dangerous drop in blood pressure caused by reduced circulating volume. These complications require urgent intervention, including airway protection, bronchial artery embolization, or surgical management in select cases.

Diagnosis and Clinical Evaluation Are Crucial

Any instance of hemoptysis warrants thorough clinical assessment. Physicians evaluate the volume of blood, frequency of episodes, associated symptoms (such as fever, weight loss, night sweats), and imaging findings like chest X-rays or CT scans to determine the underlying cause. Early diagnosis not only helps manage active TB but also identifies structural lung damage that could predispose patients to future bleeding events.

A Call for Vigilance and Timely Care

Hemoptysis in the context of tuberculosis—whether active or past—should never be ignored. It serves as a critical warning sign requiring prompt medical attention. With appropriate diagnostic tools and timely interventions, many complications can be prevented. Public awareness, especially in high-burden regions, combined with accessible healthcare, plays a vital role in reducing TB-related morbidity and mortality worldwide.