(A&E) (Haematology)

Overview

• Epistaxis = Nosebleeds → most common site of bleeding is the Kiesselbach Plexus (Little’s Area - where vessels supplying nasal mucosa anastamose with each other)
  • Most common in children and older people
• Blood flowing out nostrils → Anterior Epistaxis (90% of cases)
• Rarely blood can run down the throat → Posterior Epistaxis. High risk of aspiration and airway compromise.
• Risk Factors → dry weather, minor nasal trauma (nose picking or rubbing), primary coagulopathy (haemophilia), familial hereditary haemorrhagic telangiectasia (vascular malformation - autosomal dominant condition), granulomatosis with polyangiitis, thrombocytopaenias
  • Herediatary Haemorrhagic Telangiectasia ⇒ abnormal blood vessel formations (arteriovenous malformations). Autosomal domininant condition characterised by multiple telangiectasia over the skin and mucous membranes. Causes spontaneous, recurrent nosebleeds. First-degree relative will typically also have HHT.
  • Granulomatosis with Polyangiitis (Wegener’s) ⇒ epistaxis, sinusitis, dyspnoea, saddle shaped nose, rapidly progressive glomerulonephritis (’pauci-immune’). cANCA postive.
  • Idiopathic Thrombocytopaenic Purpura (ITP) ⇒ can cause epistaxis. Isolated thrombocytopaenia in a relatively well person. Also causes petichae and purpura. Tx with oral prednisolone.
  • Thrombotic Thrombocytopaenic Purpura (TTP) ⇒ isolated thrombocytopaenia in a very unwell person. HUS (haemolytic anaemia, thrombocytopenia, AKI) + fever + neurological signs.

Making Diagnosis

Clinical Features:

• Blood in one nostril or on both sides of nose
• Recurrent Epistaxis → suggests anterior vessel on affected side. Common in children
• Septal Deviation → increases likelihood for epistaxis

Investigations:

• Clinical Diagnosis → bleeding from nose or back of throat

Management Plan