Hemoptysis in children: Causes, Work-ups & Managements
Hemoptysis refers to the bleeding that occurs in the lower extremities and should be differentiated from bleeding from the donor nasopharynx and gastrointestinal tract. It is important to distinguish between hemoptysis and hematemesis. Hemoptysis is bright red or rust, pH is alkaline. Usually accompanied by a cough, mixed with blood in the phlegm, frothy mucus can be seen if you see a hemoptysis. Chest pain may also accompany. On the other hand, blood clots may show crimson or brown with a coffee-ground appearance and may contain food waste. It has an acidic pH, followed by nausea and vomitting.
Causes
The most common causes of hemoptysis in children are respiratory infections, foreign body aspiration, and bronchiectasis. Bronchiectasis is most common in children with cystic fibrosis. Tuberculosis is the cause of bacterial infection and histoplasmosis, coccidioidomycosis, invasive pulmonary aspergillosis, aspergilloma, and stachybotrys atra are the causes of fungal infection. Tracheobronchitis, HIV, influenza, have. Foreign body aspiration is common in children younger than 3 years of age and begins to manifest symptoms such as wheezing, chronic cough, and hemoptysis after several weeks of aspiration.
Work-ups
If the cause is unclear, try the following tests. Once a laboratory test is performed, CBC, electrolytes, bleeding dyscrasia workup (PT, aPTT, INR, studies to exclude von Willebrand disease), liver function tests (AST, ALT, alkaline phosphatase, albumin), urine analysis (hematuria) . The chest AP and chest CT can be helpful in identifying hemorrhagic location and cause lung disease. Serum tests for systemic inflammatory disease or vasculitis may also be performed. Blood, sputum cultures for suspected bacteria, fungus, and virus can be performed. Culture of suspected tuberculosis and AFB smear are performed. Flexible bronchoscopy with bronchoalveolar lavage and massive hemoptysis with rigid bronchoscopy are feasible diagnostic / interventional procedures. A lung biopsy may be needed if the cause is not known after the above tests have been performed.
Managements
If the patient is hemodynamically unstable when showing massive hemoptysis, airway intubation and mechanical ventilation, circulatory assist, and transfusion may be necessary. If active bleeding is present, bronchoscopy with hemostasis intervention or bronchial artery embolization should be performed.
Causes
The most common causes of hemoptysis in children are respiratory infections, foreign body aspiration, and bronchiectasis. Bronchiectasis is most common in children with cystic fibrosis. Tuberculosis is the cause of bacterial infection and histoplasmosis, coccidioidomycosis, invasive pulmonary aspergillosis, aspergilloma, and stachybotrys atra are the causes of fungal infection. Tracheobronchitis, HIV, influenza, have. Foreign body aspiration is common in children younger than 3 years of age and begins to manifest symptoms such as wheezing, chronic cough, and hemoptysis after several weeks of aspiration.
Work-ups
If the cause is unclear, try the following tests. Once a laboratory test is performed, CBC, electrolytes, bleeding dyscrasia workup (PT, aPTT, INR, studies to exclude von Willebrand disease), liver function tests (AST, ALT, alkaline phosphatase, albumin), urine analysis (hematuria) . The chest AP and chest CT can be helpful in identifying hemorrhagic location and cause lung disease. Serum tests for systemic inflammatory disease or vasculitis may also be performed. Blood, sputum cultures for suspected bacteria, fungus, and virus can be performed. Culture of suspected tuberculosis and AFB smear are performed. Flexible bronchoscopy with bronchoalveolar lavage and massive hemoptysis with rigid bronchoscopy are feasible diagnostic / interventional procedures. A lung biopsy may be needed if the cause is not known after the above tests have been performed.
Managements
If the patient is hemodynamically unstable when showing massive hemoptysis, airway intubation and mechanical ventilation, circulatory assist, and transfusion may be necessary. If active bleeding is present, bronchoscopy with hemostasis intervention or bronchial artery embolization should be performed.
