Pulmonary haemorrhage (bleeding into the lung)
This section has information for parents on bleeding into the lung. This is called pulmonary haemorrhage and can affect children of all ages.
On this page:
- What is pulmonary haemorrhage?
- What causes pulmonary haemorrhage?
- What are the symptoms of pulmonary haemorrhage?
- How is pulmonary haemorrhage diagnosed?
- What is the treatment for pulmonary haemorrhage?
- Useful resources
Pulmonary haemorrhage is rare. It happens when blood leaks from blood vessels in the windpipe or airways into the main lung.
Pulmonary haemorrhage can affect children of all ages.
It can start gradually and continue for a long time or it can be a sudden life-threatening event.
For premature newborn babies with a low birth weight who are already critically ill, it’s a very serious complication. They will be in intensive care and having ventilation.
There are many possible causes of pulmonary haemorrhage. In children, infection is a common cause.
Doctors are not always able to identify the cause. Where no cause can be found, this is called idiopathic pulmonary haemorrhage.
Bleeding may come from just one area of the lung, or from lots of different parts. Doctors will try to find out which. This is important because it helps them decide which treatment is likely to work best.
Bleeding from one area of the lung (localised bleeding)
Causes of localised pulmonary haemorrhage include:
- infections such as pneumonia, tuberculosis or cystic fibrosis
- congenital lung malformations
- physical trauma, for example injury in a car crash
- a weakness in the blood vessels
- lung tumours.
Bleeding from different parts of the lung (diffuse bleeding)
If the bleeding is coming from several different parts of the lung, doctors need to know if your child’s lungs are inflamed. The causes and treatment for diffuse lung bleeding with and without inflammation are different.
When there is no lung inflammation, causes of diffuse bleeding include:
- a rare lung condition called idiopathic pulmonary haemosiderosis
- complications after a bone marrow transplant
- pulmonary hypertension
If the lungs are inflamed, diffuse bleeding might be caused by conditions including:
- Goodpasture’s syndrome
- systemic lupus erythematosus
- Granulomatosis with Polyangiitis.
You may see blood in your child’s nose or on their face. In some cases, they may also be struggling to breathe.
If the bleeding is more long-term your child may have:
- weight loss
- breathlessness when they exercise
Is coughing up blood always a sign of pulmonary haemorrhage?
Coughing up blood can be a sign of pulmonary haemorrhage, but this is rare in children. This is because children tend to swallow any blood they cough up.
When children do cough up blood, it usually comes from places other than the lungs – such as the nose, or from bleeding in the gut.
Blood coughed up from the lungs is bright red and frothy. Children may feel a tingling in their throat or a gurgling in the chest before coughing up blood.
Your child may need tests to diagnose pulmonary haemorrhage and find out where the bleeding is coming from. These may include:
- chest X-ray. Blood in the lungs causes shadowing on an X-ray. If only one part of the lung is affected, this can help doctors work out where the blood is coming from and how much blood there is
- bronchoscopy. A narrow, flexible tube with a camera on the end is used to look inside your child’s lungs. This may help to confirm the site of the bleeding
- lung biopsy. Under a general anaesthetic, the surgeon makes a small cut in your child’s chest and removes some lung tissue. The tissue tells doctors more about what’s happening in your child’s lungs. This may be needed if the cause of the bleeding cannot be found.
- blood tests. If bleeding into the lung happens for a long time, it may lead to iron deficiency anaemia. Your child may have a blood test to check for this. They may also have blood tests to check for connective tissue diseases.
This will depend on how severe the bleeding is, and what’s causing it.
If your child is losing a lot of blood and it’s happening quickly, doctors will first aim to stabilise your child’s breathing and control blood loss. Your child may need to be ventilated and given a blood transfusion.
If there’s only a small amount of bleeding, it’s more important to target the cause of the bleeding.
If the bleeding is coming from one specific site in the lungs, it may be possible to stop it using:
- embolisation (blocking the blood vessels)
How effective is the treatment?
That depends. There are lots of things that will affect how well your child responds to treatment. These include
- the kind of bleeding
- how severe it is
- why it’s happening.
Talk to your health care specialists for advice about your own child and their situation.
There is more information on Acute idiopathic pulmonary haemorrhage of infancy on the chILD foundation website.
Having a child affected by pulmonary haemorrhage can be worrying. Find out where to get information and support when your child is diagnosed with a lung condition.