Coughing and vomiting blood: what you need to know

Blood brought up with a cough usually comes from the airways or lungs. Blood in vomit usually comes from the oesophagus, stomach, or upper digestive tract. Vomiting blood is an emergency; coughing up even a small streak should be assessed urgently.

Blood coughed from the chest may be mixed with phlegm and can look bright red or rusty. Blood vomited from the digestive tract may be bright red, dark red, or resemble coffee grounds. Nausea or retching before the blood favours vomiting; a chesty cough and blood-streaked mucus favour coughing. Blood swallowed from a nosebleed or bleeding mouth can blur the distinction.

Possible causes range from airway infection or irritation to a blood clot or another lung disorder. Digestive causes include inflammation, an ulcer, or a tear after forceful retching. Oesophageal cancer and stomach cancer may present with vomiting blood, but the symptom alone does not establish the cause.

If you vomit blood, go to an emergency department or call local emergency services. If you cough up a few flecks or streaks and otherwise feel stable, arrange urgent medical assessment the same day; worsening or repeated bleeding needs emergency care. Do not drive yourself if you feel faint, weak, breathless, or unwell.

Tell the clinical team whether the blood followed coughing, nausea, or retching; what it looked like; whether it was mixed with food or phlegm; and whether it happened again. Bring a current medicines list, especially if you take a blood thinner, aspirin, or an anti-inflammatory medicine. A photo can help if taking one does not delay care.

Call local emergency services for more than a few spots or streaks of coughed blood, any vomiting of blood, or bleeding accompanied by trouble breathing, chest or upper-back pain, a racing heartbeat, fainting, confusion, severe weakness, pale or clammy skin, severe abdominal pain, or black tar-like stool. These features can signal substantial bleeding or another serious problem.

Stay with the affected person while help is arranged. If they become drowsy or vomit again, keep them on their side when safe to do so and follow the emergency call handler's instructions.

Ask where the bleeding most likely started, which examination or tests could identify the source, whether any medicine should be paused or changed, and what specific recurrence signs mean you should return immediately. Also ask who will review the results and how quickly follow-up should happen.