Doctors at the University of California, San Francisco reported a case where they treated a patient who coughed up a large blood clot in the form of a bronchial tree. The report has been published New England Journal of Medicine.
A 36-year-old man was hospitalized in critical condition with worsening heart failure. His condition was so severe that doctors attached the patient to a machine called a ventricular assist device that helps the heart pump blood. This machine can also increase the risk of blood clots, so he was prescribed blood thinners.
However, these drugs increase the risk of bleeding and coughing up blood. According to the report, the patient had several coughing episodes during which a small amount of blood came out. But then, during a severe bout of coughing, the patient coughed up a “dump” of blood with bronchial branched airways. Although the man had no more cases of coughing up blood, he sadly died a week later from complications of heart failure.
Sometimes patients cough up bronchial “casts” of lymph or mucus. But blood is less stable than these substances, so the chance of “spilling” blood by coughing is almost zero. The authors reported that the patient had an infection that increased levels of the protein fibrinogen, which promotes blood clots. They think the higher fibrinogen levels help keep the man’s large blood clot intact when he coughs.