Coughing and Spitting Up Blood or Bloody Mucus

How Can the Blood Appear in the Mouth?

Blood, appearing in the mouth, can originate from the mouth, throat, nose, paranasal sinuses, voice box (larynx), windpipe (trachea), bronchi, lungs, gullet (esophagus) or stomach.

A person coughing up blood without knowing the exact cause should seek medical care promptly. Blood in the mouth may appear from banal reasons, like picking the nose or from life threatening diseases, like lung cancer.

Terms Explained

Meaning of some terms used in the article:

  • Phlegm, medically sputum, refers to mucus coughed up from the lower airways: voice box, windpipe, bronchi or lungs.
  • Post nasal drip, medically catarrh, is mucus leaking from the nose or paranasal sinuses backwards into the throat.
  • Hemoptysis (Greek haima = blood; ptysis = spitting) refers to spitting up blood that originated in the lungs or bronchi.
  • Hematemesis (greek haima = blood; emesis = vomiting) refers to vomiting blood originated in the gullet (esophagus) or stomach.

Finding the Cause of Coughing Up Blood from Symptoms

A person, spitting up blood, may suspect its origin from accompanying symptoms:

  • In a smoker, coughing up thick phlegm with blood, chronic bronchitis and lung cancer should be considered.
  • A person with chronicly blocked nose and spitting up blood can have polyps orcancer in the nose or paranasal sinuses.
  • Low grade fever, night sweats, malaise and coughing up blood , lasting several weeks to months can be symptoms of tuberculosis. Symptoms lasting few days to weeks may be from acute bronchitis.
  • High fever, rapid breathing and heartbeat, chest pain and frothy bloody mucus can be from bacterial pneumonia.
  • A person with deep vein thrombosis, experiencing sudden chest pain, low-grade fever and difficulty breathing can have pulmonary embolism.

Not Every Red Spittle Contains Blood!

Apart from the blood, the following may stain spit red:

  • Red colored foods, like beetroot, candies, artificialy colored drinks, wine, etc.
  • Saliva of patients with asthma can appear pink, if it contains large amount of eosinophils (a type of blood cells).

Bleeding from the Mouth and Throat

Bleeding from the mouth may be due to:

  • Injuries: teeth brushing, biting the tongue, tooth extraction, rough food, foreign objects, etc.
  • Dry mouth
  • Mouth sores
  • Periodontosis, an infection of gums with detached gums and loose teeth; the main cause is poor mouth hygiene.
  • Oral cancer, appearing anywhere in the mouth as a small red or white spot that can bleed; heavy drinkers and smokers are at most risk.
  • InfectionsHerpes simplex virus, shingles, measles, oral thrush (candida yeast infection)
  • Ingestion of corrosive fluids, like acids or petrol, may cause severe damage and bleeding from the mouth, throat, esophagus and stomach mucosa.
  • Lead, arsenic or mercury poisoning may cause bleeding gums.

Disorders that can cause bleeding in the mouth, nose, throat or heavy menstrual bleeding at the same time:

  • Viral hemorrhagic fevers
  • Vitamin C deficiency (scurvy) – in chronic alcoholism or other cause of inadequate vitamin C intake; symptoms include skin bruises and bleeding gums.
  • Malnutrition – due to starving, alcoholism or malabsorption – can lead to weight loss, fatigue and skin, nose or mouth bleeding.
  • Low blood platelets (trombocitopenia) – due to blood diseases, like leukemia, chemotherapy or radiotherapy.
  • Impaired blood coagulation – due to hemophilia or blood thinning medications; the main symptom is easy bleeding after small injuries.

Bleeding from the Nose and Sinuses

The blood alone or blood mixed with mucus arising from the nose or sinuses may leak into the throat as a postnasal drip and therefore appear in the mouth. Causes of nasal bleeding include:

  • Nose picking or nose injury
  • Head injury
  • Cold, dry air
  • Infections of the nose or sinuses (sinusitis)
  • Allergies
  • Inhaling irritant gases or drugs like cocaine
  • Medications
  • Nasal polyps
  • Cancer in the nasal cavity or sinuses
  • Inborn errors of nasal cavity
  • Rheumatic fever
  • SLE (systemic lupus erythematosus)
  • Barotrauma – pressure related injuries during diving or explosions
  • Other causes of nasal bleeding

Bleeding from the Trachea and Bronchi

Causes of bleeding from windpipe (trachea) or bronchi:

  • Acute bronchitis – an infection (usually viral) of the bronchi, sometimes following common cold or influenza. Coughing up yellow mucus with occasional red streaks, moderate chest pain and low grade fever are typical symptoms.
  • Inhaled foreign object may trigger dry cough and spitting up small amount of blood. Often a bronchoscopy is needed to remove the object.
  • Chronic bronchitis – coughing up yellow, green, brown or blood streaked mucus for at least 3 months, 2 years in a row, are the main symptoms. Causes include long-term smoking and irritant environmental or occupational gases.
  • Brochiectasis (Greek ectasis = dilation, widening) is a permanent widening of breathing tubes (bronchi) due to destruction of bronchial walls from repeating chronic infections. Chronic cough with yellow, green or bloody mucus and recurrent pneumonia are characteristic.
  • Bronchial (lung) cancer – newly appearing cough that does not go away, a change in a cough, coughing up bloodhoarseness and pressure or pain in the chestcan appear at early or late stage of cancer.  Bronchial cancer may press upon the vein that drains blood from the neck and head, thus causing facial and neck swelling (superior vena cava syndrome). Poor appetite and weight loss are late symptoms. Diagnosis is with a chest X-ray and bronchoscopy.

Bleeding from the Lungs

Causes of bleeding from lungs:

  • Violent cough can cause a rupture of the lung arteries.
  • Bacterial pneumonia  – symptoms include: suddenly appearing high fever, rapid breathing and heartbeat, coughing up green or rusty sputum. Non-treated pneumonia can be deadly.
  • Tuberculosis – symptoms include: low grade fever, night sweets, feeling unwell, slowly developing dry cough that may later contain yellow/green or blood streaked phlegm.
  • Pulmonary edema is a life threatening condition refering to fluid collection in the lungs due to heart failure, living on high altitudes (climbers), certain medicines, irritant gases, inhaling vomit content, etc. Extreme shortness of breath, paleness, anxiety and spitting up pink frothy mucus are main symptoms.
  • Pulmonary embolism refers to blockage of a pulmonary artery by a blood clot, often dislodged from the leg or arm veins in deep vein thrombosis. Sudden chest pain resembling heart attack, shortness of breath and coughing up frothy red streaked sputum are main symptoms.
  • Trauma to the chest: pressure of a steering wheel in car accidents, falling from height, knife, shooting or blast (explosion) injuries can all cause lung bleeding.
  • Sarcoidosis is a chronic inflammation of uncertain origin, affecting several organs, mainly the lungs; chronic fatigue, night sweets, skin rashes, and, rarely, coughing up bloody mucus are possible symptoms. X-ray of lungs shows enlarged “hilar nodes” – lymph nodes at the point where main bronchi enter the lungs.

Vomiting Blood (Hematemesis)

Blood in the vomit may arise from the:

  • Esophagus: esophageal varices in alcoholic cirrhosis or chronic hepatitis; tear in the lower part of esophagus during violent vomiting (Mallory-Weiss syndrome); esophageal ulcers due to severe gastric acid reflux; esophageal cancer
  • Stomach: gastritis, gastric ulcer or cancer, injury
  • Wind pipe (trachea) – when blood is swallowed. Detailed list of causes of vomiting blood.

Related Articles:

About Jan Modric (249 Articles)
Health writer

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  • Rafael

    Thanks Dr. I am short of breath at times but I went to a gastro dr. and he told me that small amounts of blood with mucus can’t be bleeding in the gut or esophagus, but I’m not sure if that’s true. I have all the symptoms of acid reflux or gastritis and sinus infection as well. I feel the bleeding comes from the throat because my ear and throat have been irritated for a while now. So many symptoms I don’t know which is causing what… 🙁 What should I get tested for?

  • Chris M

    I have this nose and chest cold and recently noticed that there was blood in my mucus. My symptoms are a wet cough with a stuffy and sometimes runny nose (my nose alternates between the two). I have not had any fevers or anything. But the blood was stringy and bright red I belive it came from my lungs but could be wrong cause I noticed it was coming from my nose too. I have a doc appointment tomorrow and am worried that I have cancer… I am 21 year old male and have been a smoker since I was 15

  • Dr. Chris

    Hi Rafael

    Sinusitis is a common cause of blood in the sputum so this should first be assessed and treated. The other conditions can actually wait until after your sinusitis has been treated effectively. The reflux should be treated in the long run and managed appropriately.

  • Dr. Chris

    Hi Chris M

    No need to assume that it is cancer just yet although being a smoker does greatly increase the risk. A cold is a viral infection that is often followed by a bacterial infection (secondary). The inflammation of the lining of the nose, coupled with an infection, does result in some bleeding. This is further compounded by infection of the sinuses. The mucus may vary from clear to brown with bright red blood that is passed out during blowing the nose or sneezing. It needs to be attended to though and your doctor will investigate further.

  • Jack

    I was involved in an accident where I had few face injuries and fractured back side of my shoulder!!! after a week has passed and when I spit cough it is thick dark red colored(black)!! I informed the same to the doctor after 2 days and doctor said it might take 15 days as you had face and head injuries!!
    what would u suggest me to do doc???

  • Milla

    I woke up feeling a familiar pain on my throat followed by light green mucus with blood in it… I have had bronchitis two times in 2011 …I was told I had asema and I was giving antibiotics but it comes right back a month or two later. I do smoke and drink occasionly. Please help. I feel like there is something more to it.

  • Rija Khawar

    Hi, I have had a thyroidectomy due to medullary carcenoma and the doctors suggested radiotherapy. after about 2 months of it I started experiencing dry cough with blood in it. doctors say its a side effect of radiotherapy. plz advise.

  • Hi Rija. It is possibly a side effect of the radiation therapy you are undergoing. You should speak to your oncologist about what you can do to minimize the dryness while not interfering with your treatment. If you are unhappy with the advice of your doctor, seek a second opinion from another specialist. Do not attempt to stop your treatment or interrupt it anyway to avoid these unpleasant symptoms.

  • Charna Mccormick

    hi i’ve been regulary spitting up blood mucus in the mornings its now more often ! i’ve had gum infection but have cured it wondering could it be anythink to do with that i’ve been to the dentist but theres not problems i think i should about to the doctors !

  • Hi Charna. You definitely have to see a doctor immediately. While gum disease does cause symptoms like this, if your dentist has given you the all clear then it is likely to be from some other cause. There may be some gum disease that is so minor that your doctor could not spot it. But if so, then it is unlikely to be causing this type of bloody mucus.

    There are many possible causes – some serious, others not so much so. TB and cancer of the esophagus or throat are some of the very serious causes and you will only know for sure once your doctor does further investigations.

  • Charna Mccormick

    i do also have a bad taste in my mouth regulary but i dont have bleeding gums ! i’ve had this for about 3years now ive tryed mouth washes toothpaste just seems to make it worse ! always got mucus in my throat and either bloody or darkish !!! shall get a appointement to the doctors !

  • Hi Charna. As we mentioned in our previous reply, you should see a doctor. It could be bleeding gums although you may not see the bleeding come from the gums itself. What is even more worrying is this blood mucus in your throat when you wake up in the mornings. As previously explained this could be serious conditions such as TB or even throat cancer. Hopefully it is not these conditions but until you see a doctor you will not know for sure.

  • hugolopez

    alright so my friend spits out blood and sometimes loses her vision to the point she sees black and then it comes back blurry slowly as time goes til she can see again she also gets real hot and a huge headaches that she wants to past out from we took her to the hospital but they say everything was normal and if it happens again to come back to see if theirs like a pattern to find the source of it she also cant eat no more like she scared to eat now

  • Gail Hyde

    I had massive bleeding from mouth ,woke up in night with mouthful of blood,and then just kept coughing blood up,went hospital,tests,no temp,had x ray comparison to a 6 year old x ray and now ,no change, ct scan ,nothing,nose scope,throat scope,stomach scope and and one in my lungs,tiny bronitisis. Eventually stopped after antibioics, tiny ulcer in osophegus.How can such a thing happen? The amount of blood I was losing was half pints! Not inconsiderable. They could not find the source of the blood (very bright red) But I could hear it bubbling…….At home now ,horrible chest infection (did not have one when I went in!) .Forgot blood tests were fine,white and red normal,o2 levels 98%.

  • Hi Gail. Do not underestimate a bleeding ulcer. There can be quite a bit of blood loss from the area and when mixed with saliva and mucus from the esophagus it may make up quite a large volume. Of course there is also the possibility that it did not emanate from the ulcer. It would be advisable that you follow up with your family doctor and possible get a referral to a gastroenterologist or otorhinolaryngologist (ENT specialist) for further investigations.

  • Lay lay Mariah

    This morning, I hacked up mucus with blood. What could it mean?

  • Najy

    I am moving hse & there is lots of dust everywhere. I have been having quite a dry nose so I have been applying vaseline to avoid it. The other morning I had a very uncomfortable dry & tickly cough after breathing in dust. Following the tickly cough I coughed up blood but it was on one only occasion. Do u think this is to worry about? Thanks

  • Hi Lay lay. Hopefully it has not occurred again but you should have it checked up by a doctor. Bloody mucus can occur with various acute infections but in some instances it can be a sign of serious diseases like TB and even lung cancer. Don’t immediately assume the worst but don’t leave it unattended. Your doctor will be able to guide you further and will probably want to run further tests before reaching a diagnosis.