about the blood in my sputum

[ud23]

Dear Doc,

I am 25yr old female, height 165cms, weight 52kgs, around 3yrs before I was diagnosed for TB with the result of X-ray and CT-Scan stating that my left lung was infested with the organism and a cotton ball like structure appeared in the X-ray. The symptoms were high fever, nausea, loss of appetite. As per my physicist advise, I had to take a session for close to 6 months with the strong doses of antibiotics mainly of isoniazid, rifampsin... After my session, my doc said I am completely out of it after checking with my X-ray report and nothing to worry about anymore. After that, I do have cold all the time, but was said nothing to do with TB.. So, everything went fine.. But, today after close to 3yrs, I found blood in my sputum { I had really pretty hot beverage, soup today, could that have anything to do with the blood}. Should I have to panic about this.. Because, as far as I have studied, MTB tends to gain resistance to the antibiotics more readily. The first time I  was given heavy dose of them, I do not know if things ll work out the 2nd time. Please provide me with your valuable advise.

Looking forward for your immediate response.
Thank you

[David Tinkelman, M.D.]

Blood in one’s sputum is reason for concern but I would be reluctant to conclude that it is a sign of recurrent TB.  The matter could be settled with a high degree of certainty by a chest X-ray and then culture of your sputum for TB.  

It is quite unlikely that drug resistant TB would emerge after 3 years after an apparently very good respond to the original therapy.  There is another possibility and that is this:  after one has TB, there can be permanent lung damage, even with good healing, that results in a condition, usually localized in the lung, called bronchiectasis.  This lung disease can cause bleeding, even in the absence of recurrent TB infection.

Your doctor’s approach to this incident, should be to rule-out recurrent TB with the X-ray and sputum exam and then do whatever diagnostic testing is necessary to determine the source of the blood.  The source by the way could be anywhere in the respiratory tract, from the sinuses to the outermost parts of your lungs.

An additional thought: If the hot soup were so hot that you felt as if your throat had been burned, that could cause minimal bleeding, but it is highly unlikely and most likely will not recur.

Good luck

[AndyRRT]

Finding blood in sputum is always alarming. It can be caused by lung infection, cancers, or or simply by a coughing jag. wen ever I observe blood in any of my patients sputum, I always send of cultures to rule out infection.

Keep an eye on your sputum production and always-always-always report this back to your doctor. Is the blood bright red or does it look old (rusty)