The first sputum with blood in the morning may be caused by pneumonia, bronchial dilatation, tuberculosis, bronchopulmonary cancer and other diseases. 1. Pneumonia: Pneumonia can cause coughing, coughing up sputum, coughing violently will cause small bronchial blood vessel rupture and cause blood in sputum symptoms. 2. Bronchial dilatation: bronchial dilatation is a respiratory disease caused by long-term infection of bronchial-lung tissues and bronchial obstruction infection, bronchial dilatation can cause coughing, coughing up a lot of sputum, which can be accompanied by blood in sputum. 3. Tuberculosis: Tuberculosis is caused by infection of lungs with Mycobacterium tuberculosis and destroys lung tissues, which can cause cough, hemoptysis and other symptoms. 4. Bronchopulmonary cancer: it is a malignant tumor occurring in bronchial tubes and lung tissues, which mostly occurs in the elderly patients, and coughing, coughing sputum, hemoptysis and weight loss are the common manifestations. Because cancer destroys blood vessels, it can cause hemoptysis and blood in sputum. There are many other causes of blood in the first sputum in the morning, and it is recommended to go to the hospital for examination to find out the causes.