Blood coming after sleeping and waking up I feel like something accumulated and when I spit it it was blood with clots I went to hospital but doctor told everything is normal xray shows old tb only he suggested ct scan
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"hemoptysis"[MeSH Terms] AND "tuberculosis"[MeSH Terms]
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What you're describing is hemoptysis, which means coughing up blood from the lungs or airways. A history of old TB makes it important to find the cause. Your doctor's advice to get a CT scan is correct, so please don't skip it.
Why the CT scan matters
A chest X-ray can miss the cause of bleeding. The Harrison's chapter on hemoptysis says it is expectorated blood from the lower respiratory tract. It also says the amount and frequency of bleeding are the most important details, because heavy bleeding needs emergency treatment (Harrison's Principles of Internal Medicine 22E, p. 635). For stable patients, the same book says CT, particularly CT angiography, finds the bleeding source and the underlying disease with high sensitivity.
Likely causes in someone with old TB
Some of these are inferred from your history and are not stated in the textbook passages I pulled.
- Scarring and widened airways (bronchiectasis) left behind by TB. This is a common cause of recurrent bleeding years later.
- A fungal ball (aspergilloma) growing in an old TB cavity. Harrison's notes that cavitary lesions with Aspergillus can cause serious hemoptysis.
- Active TB coming back. An old X-ray scar doesn't rule this out.
- Other lung infections or inflammation of the airways.
- Lung cancer. Harrison's says lung cancer accounts for a large share of hemoptysis cases, and up to 20% of lung cancer patients have hemoptysis at some point. A CT is the way to check for it, especially if you smoke or are over 40.
- Bleeding from outside the lungs. Blood from the nose, throat or stomach can look like coughed-up blood. Pooling overnight and clots on waking can fit this, so your doctor may also look at your nose and throat.
What to do now
- Get the CT chest soon. A contrast CT or CT angiography is often best. Take your old TB records and X-rays to the appointment.
- Ask about a sputum test for AFB and GeneXpert to check for active TB. You may also need a CBC, a clotting profile, and possibly bronchoscopy if the CT doesn't explain the bleeding.
- Note how much blood you cough up. Estimate it in teaspoons or cups, and say how often it happens.
- Tell the doctor about any blood thinners, aspirin or NSAIDs, smoking, weight loss, fever or night sweats.
Go to the emergency room immediately if
- You cough up more than about a cupful (roughly 100 to 150 mL) of blood in 24 hours, or bleeding is ongoing.
- You feel breathless, dizzy, faint, or have chest pain.
- You have fever with a worsening cough.
- The bleeding keeps coming back.
If heavy bleeding happens, lie on the side you think is bleeding, if you know which one, and get emergency help. Bleeding that is heavy or keeps coming back can be treated with bronchial artery embolization. Harrison's reports it controls brisk bleeding in 75 to 90% of patients.
Recent evidence check
A quick PubMed search turned up two recent reviews. One is a 2025 systematic review of bronchial artery embolization (PMID 41286932). The other is a 2024 meta-analysis on bronchoscopy when CT is negative (PMID 38350978). Neither contradicts the approach above.
I can't tell you the cause from this description alone, because it depends on your CT result. If you tell me your age, whether you smoke, how much blood there is, how often it happens, and whether you have fever or weight loss, I can help you work out how urgent this is.
Create a checklist of symptoms to track before my visit 27 yrs No smoking Day before yesterday it is 3 tablespoons yesterday night it is 2 today it is like 6 times and at nyt it is like 8 times the amount of first one No fever I had c-section before delivery my wt is 89 after it is 82 now my wt id 74 c section happened on august 10
Your numbers show the bleeding is getting worse, so please don't wait for a routine visit. If the last amount is right, go to an emergency department tonight.
What your numbers suggest
- Day before yesterday: about 3 tablespoons (about 45 mL).
- Yesterday night: about 2 tablespoons.
- Today: about 6 episodes.
- Tonight: about 8 times the first amount. That would be roughly 24 tablespoons, or about 350 mL.
If that last figure is right, it passes the threshold Harrison's gives for life-threatening hemoptysis (more than about 150 mL in 24 hours, or 100 mL per hour). Those patients need emergency care. I can't confirm the volume from here, so please measure it. A cup is about 240 mL and a tablespoon is about 15 mL.
You should go in tonight because you are also about 12 weeks after a C-section and have old TB. After childbirth, a pulmonary embolism (a clot in the lung) can cause coughing up blood, and TB can flare up. Both need prompt testing. The cause could also be bronchiectasis, a fungal ball, or something else, and only imaging can sort that out.
On the way to the hospital:
- Sit upright or lie on the side you think is bleeding.
- Don't eat or drink, in case you need a procedure.
- Take your old X-ray, TB records and C-section discharge papers.
- Ask someone to go with you. Don't travel alone.
Call emergency services instead of travelling yourself if you cough up a cupful or more, feel faint, become short of breath, have chest pain, or have a racing heart.
Symptom checklist to track and tell the doctor
1. Bleeding log. Write down the time, the amount (teaspoons, tablespoons or cups), the colour (bright red, dark, or clots) and whether it is mixed with phlegm or froth. Note whether it comes after lying down or sleeping, and whether it comes with coughing. Check whether it is truly from the chest, not the nose, throat or stomach.
2. Breathing and heart. Note any of these:
- shortness of breath
- chest pain, especially sharp pain when you breathe in
- a racing heart or palpitations
- dizziness or fainting
- swelling or pain in one leg (a sign of a possible clot)
- pink frothy sputum, or being unable to lie flat
3. TB-type symptoms. Note any of these:
- cough lasting more than 2 weeks
- night sweats
- evening fever (you've had none so far, so keep checking with a thermometer)
- loss of appetite
- tiredness
- swollen glands
4. Weight and nutrition. You went from 89 kg to 82 kg after delivery, and now to 74 kg. Some loss after childbirth is normal. Dropping another 8 kg since delivery is a lot, though, especially with old TB. Tell the doctor whether you are dieting and whether you are breastfeeding. Note any weakness too.
5. Other bleeding and anemia clues. Note any of these:
- nosebleeds
- bleeding gums
- easy bruising
- heavy vaginal bleeding since delivery
- black stools or vomiting blood
- paleness or fatigue
6. Postpartum and medical history. Note any of these:
- clots or blood pressure problems in pregnancy
- a long period of bed rest after the C-section
- calf pain or swelling since delivery
- any heart murmur or rheumatic fever history
- family history of clots or bleeding
7. Medicines and exposures. Note any of these:
- aspirin or painkillers (NSAIDs)
- blood thinners (including injections after the C-section)
- contraceptives or hormones
- TB contact at home
- how complete your old TB treatment was (the dates and whether you finished it)
Questions to ask the doctor
- Do I need a CT pulmonary angiogram to look for a clot, or a CT chest to look at the lungs?
- Can I have sputum tests for TB (AFB and GeneXpert) and blood tests (CBC and clotting)?
- Could this be a fungal ball, bronchiectasis, or something else left over from my old TB?
- Is bronchoscopy or bronchial artery embolization needed if the bleeding continues?
- If I'm breastfeeding, which tests and medicines are safe?
Please tell me what the actual amount tonight is. I can help you work out how to describe it to the emergency team.
Search PubMed for postpartum causes of coughing up blood What is ct plumonology angiogram Yes I used aspirin during pregnancy and after deliver I used amlovas 2.5 mg it is only 3to 4 days since I stopped I had heavy vaginal bleeding also I had subinvolution of uterus due to infection so I had symposium like fever during evening times body pains loss of appetite although I'm breastfeeding
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"hemoptysis"[MeSH Terms] AND "postpartum period"[MeSH Terms]
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"pulmonary embolism"[MeSH Terms] AND "postpartum period"[MeSH Terms]
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"tuberculosis"[MeSH Terms] AND "postpartum period"[MeSH Terms]
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Please go to an emergency department today. Don't wait for an outpatient appointment. Your new details add several postpartum causes that need same-day tests. Bring up each one with the team.
1. PubMed search: postpartum causes of coughing up blood
There are no large studies of postpartum hemoptysis. The literature is mostly case reports and reviews. I only had titles and indexing to go on, not full abstracts. The main causes that came up:
| Cause | Why it fits you | Source |
|---|---|---|
| Pulmonary embolism (blood clot in the lung) | The weeks after a C-section carry a raised clot risk. You also had infection, heavy bleeding and likely high blood pressure. | 2026 meta-analysis on diagnosing postpartum PE; 2022 review of PE in pregnancy and the puerperium |
| TB flare after delivery | You have old TB, and pregnancy and the postpartum period can reactivate it. | Review of TB in pregnant and postpartum women; postpartum TB case report |
| Lung blood vessel inflammation (vasculitis) | A case report describes postpartum hemoptysis as the first sign. | Case report |
| Tumors, including choriocarcinoma | A case report links postpartum hemoptysis to this rare pregnancy-related cancer. | Case report |
| Heart valve problems or other lung and airway causes | These are listed in the wider pregnancy hemoptysis literature. | 2023 review |
Your own history also points to these:
- Uterine infection with subinvolution and heavy vaginal bleeding. Infection can seed clots or infected material into the lungs.
- Amlodipine (Amlovas), which suggests you had high blood pressure after delivery. Stopping it 3 to 4 days ago can let your BP rise again. Severe postpartum high blood pressure can cause fluid and blood-tinged sputum in the lungs.
- Evening fever, body pains, appetite loss and weight loss. This pattern also fits TB, not only the uterine infection.
- Blood loss. Heavy bleeding can cause anemia, which makes any lung bleeding more dangerous.
Choriocarcinoma is rare. If there is any doubt, ask for a serum beta-hCG test. It is a simple blood test, and heavy vaginal bleeding together with coughing blood after pregnancy is the setting where doctors check it.
2. What is a CT pulmonary angiogram (CTPA)?
It is a chest CT scan done with contrast dye injected into a vein, usually in the arm. The scan is timed to catch the dye while it fills the arteries of the lungs.
- What it shows: blood clots in the lung arteries. It also shows the lung tissue itself, including TB scarring or cavities, widened airways (bronchiectasis), a fungal ball, masses, and bleeding areas.
- How long it takes: the scan takes a few minutes. You lie flat and hold your breath briefly. The dye may make you feel warm for a moment.
- Why it suits you: Fishman's says that when the chest X-ray is abnormal, CT angiography is more likely to give a definitive diagnosis of PE or an alternative diagnosis (Fishman's Pulmonary Diseases and Disorders, p. 549). Your X-ray already shows old TB changes.
- Before the scan: tell the team if you have kidney problems or a past allergy to contrast. They may check your kidney function. They should also know you are breastfeeding.
- Breastfeeding: from my own knowledge, not these sources, iodinated CT contrast passes into breast milk in very small amounts. Major radiology guidance says you generally don't need to stop breastfeeding. Ask the radiologist to confirm.
- If CT isn't possible: a V/Q scan is an alternative for suspected clots. But with an abnormal X-ray, CT is usually preferred.
3. What to tell the emergency team
- You have been coughing up blood for 3 days, and it is increasing: 3 tablespoons, then 2, then 6 episodes today, then about 8 times the first amount tonight. Measure it if you can.
- You had a C-section on August 10, followed by heavy vaginal bleeding and a uterine infection with subinvolution.
- You have a history of TB.
- You took aspirin in pregnancy, and amlodipine 2.5 mg after delivery, which you stopped 3 to 4 days ago.
- You have had evening fever, body pains, appetite loss and weight loss (89 kg, then 82 kg, now 74 kg).
- You are breastfeeding.
Tests to ask about:
- BP and oxygen level
- CBC (for anemia) and a clotting profile
- CTPA or CT chest
- Sputum for AFB and GeneXpert
- Beta-hCG
- A pelvic ultrasound, to check the uterus for retained tissue or infection
If TB is a possibility, ask what precautions to take around your baby while results are pending.
Call an ambulance if you cough up a cupful or more, faint, have chest pain or severe breathlessness, or get a severe headache or blurred vision (which can signal very high BP).
If you tell me what your BP reading is, and whether the blood is bright red or dark, I can help you describe it to the team.
How do doctors treat hemoptysis if bleeding doesn't stop?
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"hemoptysis"[MeSH Terms] AND "tranexamic acid"[MeSH Terms]
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"hemoptysis"[MeSH Terms] AND "therapy"[Subheading]
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Treatment goes in steps: protect the airway, stop the bleeding, find the cause, then prevent it coming back. Schwartz's lists the same priorities: stabilize breathing and prevent asphyxiation, localize the bleeding site, control the hemorrhage, determine the cause, and prevent recurrence (Schwartz's Principles of Surgery, 11th ed., p. 745).
Step 1: Stabilize
For significant bleeding that is not immediately overwhelming, Schwartz's describes these measures (Schwartz's Principles of Surgery, 11th ed., p. 745):
- ICU or monitored admission with strict bed rest.
- Lying with the bleeding side down, if the side is known. This keeps blood out of the healthy lung.
- Humidified oxygen, large IV lines, and monitoring of oxygen levels.
- Cough suppression and mild sedation.
- Nebulized adrenaline.
- Correcting any clotting problem and giving antibiotics if there is infection.
- IV vasopressin where it is not contraindicated.
If bleeding is so fast that breathing is threatened, the airway comes first. Tintinalli's says massive hemoptysis requires airway control, plus interventional radiology for bronchial artery embolization and emergent bronchoscopy (Tintinalli's Emergency Medicine, Ch. 63). Intubation may be needed.
Step 2: Find the bleeding site
- CT angiography. Tintinalli's says multidetector CT and bronchoscopy give the best outcomes, with most recommending CT first. CT angiography shows the abnormal bronchial and other arteries that can then be targeted.
- Bronchoscopy. A camera passed into the airways finds where the blood is coming from.
Step 3: Stop the bleeding
Through the bronchoscope (Fishman's Pulmonary Diseases and Disorders, p. 658):
- Iced saline or dilute adrenaline into the bleeding airway to constrict vessels.
- A balloon catheter to tamponade the bleeding airway, or a blocker that seals off the whole bronchus.
- Cellulose packing to form a clot in a small segment.
- Laser or argon plasma coagulation for visible bleeding points.
- Removal of large clots. Rigid bronchoscopy is generally preferred for massive bleeding.
Fishman's notes these are often temporary measures while definitive treatment is arranged.
Bronchial artery embolization (BAE). Most massive bleeding comes from the bronchial arteries, so this is usually the next step. A radiologist threads a catheter up from the groin, finds the bleeding artery, and blocks it with particles.
- Schwartz's reports immediate control in over 80% of patients.
- Harrison's gives 75 to 90%. It also warns that rebleeding occurs in 20 to 50% of patients if the underlying cause isn't treated, and that a repeat embolization usually works.
- Side effects can include chest pain, fever and trouble swallowing for 5 to 7 days. Serious complications such as spinal cord injury are rare.
- If bleeding continues, a pulmonary artery source is suspected (Schwartz's).
Tranexamic acid (an antifibrinolytic). It is given by mouth, IV, or as a nebulizer. A 2025 meta-analysis of inhaled tranexamic acid for non-massive hemoptysis and a 2025 integrative review of nebulized use both cover it. I only saw their titles, not their results, so I can't give you the effect size. Older trial evidence is limited.
Surgery (resecting the bleeding lung segment). This is for bleeding that embolization and other measures can't control. Harrison's says surgery is better done in a non-urgent setting when possible.
Step 4: Treat the cause
This prevents recurrence, and the cause decides the treatment.
- TB: anti-TB drugs after confirming active disease.
- Pulmonary embolism: anticoagulation. Doctors weigh this carefully when there is active bleeding, and the plan may include a vena cava filter. This is the main reason for a CT angiogram before starting any blood thinner.
- Aspergilloma: antifungals, embolization, or surgery.
- Bronchiectasis or infection: antibiotics and airway clearance, with embolization if bleeding recurs.
- Cancer or choriocarcinoma: specific oncology treatment.
For recurrent bleeding, a 2024 meta-analysis compared BAE with conservative treatment, and a 2025 systematic review covers BAE outcomes. I didn't read their results either.
What this means for you
Your bleeding has been increasing over three days, and your risk factors include a recent C-section, a uterine infection, and old TB. That is why you should be seen in an emergency department rather than wait. They can do the CT angiogram, check your blood count and clotting, and arrange bronchoscopy or embolization if the bleeding continues. Most people with hemoptysis stop bleeding with the first measures. The treatments above exist for those who don't, and they work best when started early.
If you have not been seen yet, please go now. Tell me where things stand, and I can help you prepare questions for the team.
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