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TDF 2019 Stage 18 replay

I have been watching the Eurosport replays of last years tour. I forgot about the blood on Quintana’s jersey.
Reading all the articles available they all skirt around the issue of how this may have happened.
From what I understand he coughed up some blood towards the end of the stage while cycling. There’s just nothing I can think of that makes the possibility of this a healthy response, and seems suspicious. Does anyone have a reasonable explanation of this?

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