General approach to evaluation and management of the child presenting with non-life-threatening hemoptysis

CBC: complete blood count; CT: computed tomography; ET: endotracheal; CF: cystic fibrosis; PBB: protracted bacterial bronchitis; NSAIDs: nonsteroidal antiinflammatory drugs; BPAP: bilevel positive airway pressure; BAE: bronchial artery embolization.

* Bleeding from the upper respiratory tract, oropharynx or nasopharynx, or upper gastrointestinal tract (eg, from esophageal varices due to cirrhosis) is relatively common and can mimic true hemoptysis.

¶ We define hemoptysis severity based on approximate estimates of bleeding and other clinical signs, as follows:

• Scant – <5 mL.

• Mild or moderate – ≥5 to 200 mL of blood within 24 hours, with no hemodynamic instability or impaired gas exchange.

• Life-threatening or massive – ≥200 mL within 24 hours and/or evidence of hemodynamic instability (tachycardia, hypotension), abnormal gas exchange, difficulty maintaining a patent airway, or very brisk bleeding. These categories are similar to those used in a CF consensus guideline^[1].

Δ For patients with scant hemoptysis (<5 mL), optimize outpatient treatment for the known/presumed underlying cause, similar to patients with greater hemoptysis severity. If the cause is unknown, these patients may warrant further evaluation, as summarized in the inset.

◊ For patients with CF, treatment of mild or greater hemoptysis should include antibiotics, stopping of NSAIDs, and suspending inhaled hypertonic saline^[1]. For patients with suspected vasculitis, treatment generally includes glucocorticoids and/or other immunosuppressive drugs (refer to appropriate UpToDate content).