Minor haemoptysis seen in the community

Not a laboratory test

• Contrast-enhanced chest CT (CT angiography): first-line test according to the French reference document; failing that, PA and lateral chest X-ray, then CT if it finds no cause.

Laboratory tests

• FBC
• Serum creatinine with eGFR
• PT, aPTT (if known coagulation disorder or anticoagulant)if neededHistory of haemostasis disorder or anticoagulant treatment: assess coagulation ^[3]. On a VKA, request the INR (see the “Treatment: vitamin K antagonist (VKA)” page). The coagulation tests (FBC, PT, INR, aPTT, anti-Xa activity or specific assay on a direct oral anticoagulant) look for a coagulation disorder or anticoagulant overdose, which cannot by itself be the cause of the haemoptysis ^[4].
• ASTif needednon-French guidelineIn the United States, the American Family Physician includes a full biochemical panel among the tests for every patient, notably because liver disease can disturb platelets and coagulation ^[3]. The French teaching reference does not cite it in its coagulation tests ^[4], hence the option, limited to the relevant patient group.
• ALTif needednon-French guidelineIn the United States, the American Family Physician includes a full biochemical panel among the tests for every patient, notably because liver disease can disturb platelets and coagulation ^[3]. The French teaching reference does not cite it in its coagulation tests ^[4], hence the option, limited to the relevant patient group.
• Bilirubinif needednon-French guidelineIn the United States, the American Family Physician includes a full biochemical panel among the tests for every patient, notably because liver disease can disturb platelets and coagulation ^[3]. The French teaching reference does not cite it in its coagulation tests ^[4], hence the option, limited to the relevant patient group.
• Acid-fast bacilli (mycobacteria) in sputum, 2 to 3 samples (if tuberculosis possible)if neededFever, weight loss, productive cough, history of tuberculosis: sputum examination for acid-fast bacilli (and IGRA depending on the context) ^[3]. Tuberculosis is the leading cause of haemoptysis worldwide ^[3]. Write “AFB testing” (acid-fast bacilli): a standard sputum culture does not include it. First-line, 2 to 3 samples, not necessarily on 3 consecutive days (possible within 24 hours); a negative direct examination does not rule out the diagnosis ^[5]. Symptomatic patient suspected of pulmonary tuberculosis: samples taken in hospital, in a single room with airborne isolation ^[5].
• Sputum culture (if respiratory infection suspected)if needednon-French guidelineSuspected infectious cause (bronchitis, pneumonia, abscess, infected bronchiectasis): sputum examination with Gram stain and culture ^[3].
• Aspergillus serology (if cavity, tuberculosis sequelae)if neededPossible chronic pulmonary aspergillosis (cleaned-out tuberculous cavity, cavity): Aspergillus serology, and in some cases Aspergillus antigen and mycological examination of sputum ^[4].
• NT-proBNP (if heart failure possible)if needednon-French guidelineSuspected congestive heart failure as the cause of the haemoptysis ^[3].
• ANCAif needednon-French guidelineSuspected immunological disease or vasculitis (synovitis, skin signs of autoimmune disease): antibodies (ANCA, antinuclear, anti-dsDNA, anti-glomerular basement membrane, anticardiolipin) and inflammatory markers ^[3].
• CRPif needednon-French guidelineSuspected immunological disease or vasculitis (synovitis, skin signs of autoimmune disease): antibodies (ANCA, antinuclear, anti-dsDNA, anti-glomerular basement membrane, anticardiolipin) and inflammatory markers ^[3].