Cough, Blood

I have been coughing up phlegm now for about 5 months. Mostly it is just clear but can sometimes be a small like ball but it is hard and clear. Sometimes the ball can be a brownish color. Most of the phlegm I cough up is brownish or yellowish. I developed a dry unproductive cough about 6 weeks ago but after about 2 weeks it became productive and I havent really suffered with it that much over the last 3 weeks.

Last night I started having a very mild dry tickly cough. I wasnt coughing bad just a cough here and there. I went to bed and when I woke up I cleared by throat and when I spit there was bright red blood in the phlegm. This went on for about 10 minutes.

I went straight to the ER and the Dr did the following checks:

*Dr listened to my chest & said that he didnt hear anything other than a slight wheeze on the left side. Other than that he said it was clear. *He took blood from my pulse and did an blood gas test??-He said this was fine.*He tested my oxygen levels-He said I was at 92% which was fine.
Last but not least, he took and xray of my chest. He said that he did not see anything suspect. Other than having smokers lungs (I smoke), he said there wasnt anything else there that was found that would cause him to worry.
Last night I fell asleep in front of our gas fireplace. Is is possible that the heat dried out the lining/membranes and when I went on upstairs to bed and slept for a few hours the vessle broke and then the blood gathered at the back of my throat?

I would just like your opinion based on what I have told you and also some possible other causes of fresh blood in phlegm. The amount of blood each time was about the size of a dime.


Thanks.

[National Jewish Health]

What you describe is serious and efforts should be made to determine the source of the blood.  Assuming that this truly was coughed and not vomited blood, it could originate anywhere in your respiratory system, from nose on down to lungs.  The negative chest x-ray is re-assuring but does not rule out the possibility of bleeding from a site in your windpipe and large bronchi.  Since the blood "gathered in your throat", as opposed to having been coughed-up, suggests a source in your nose, sinuses or throat.

You should, without delay see an ENT specialist or a lung specialist, for further evaluation to include fiberoptic laryngoscopy of your nose, throat and larynx.  If that fails to reveal a bleeding site, you should then have a CT of the sinuses and, if negative, bronchoscopy performed by a pulmonologist.  You should insist that your doctors proceed until either a site of the bleed has been found or all appropriate diagnostic studies are negative.

The best way for a cause to be found would be for you to go to a large hospital ER, when bleeding recurs and is active.

Good luck