Diagnosis, Tests, Management and Treatment

Overview

What is hemophilia?

Hemophilia is a rare, inherited bleeding disorder in which blood cannot clot normally at the site of a wound or injury. The disorder occurs because certain blood clotting factors are missing or do not work properly. Because a clot does not form, extensive bleeding can be caused from a cut or wound. This is called external bleeding. Bleeding inside the body, called internal bleeding, can occur as well, especially in muscles and in joints like the hips and knees.

Hemophilia affects males almost exclusively, but there are rare circumstances when a female can be affected with the disorder.

There are two main types of inherited hemophilia:

• Type A, the most common type, is caused by a deficiency of factor VIII, one of the proteins that helps blood to form clots. This type is known as classic hemophilia.
• Type B hemophilia is caused by a deficiency of factor IX. This type is also called Christmas disease.

Although hemophilia is usually diagnosed at birth, the disorder can also be acquired later in life if the body begins to produce antibodies that attack and destroy clotting factors. However, this acquired type of hemophilia is very rare. Acquired hemophilia is also called autoimmune hemophilia, or acquired hemophilia A (AHA).

How common is hemophilia?

Hemophilia is a rare disorder. It can occur in all races and ethnic groups. Hemophilia A affects 1 in 5,000 to 10,000 males. Hemophilia B is less common, affecting 1 in 25,000 to 30,000 males.

Around 60% to 70% of people with hemophilia A have the severe form of the disorder and about 15% have the moderate form. The rest have mild hemophilia.

Is hemophilia contagious?

No. Hemophilia is caused by mutations in the genes encoding factor VIII and IX. You can’t catch it from someone who has it like you can catch a cold.

Symptoms and Causes

What causes hemophilia?

The genes that regulate the production of factors VIII and IX are found on the X chromosome only. Hemophilia is caused by mutations in either the factor VIII or factor IX genes on the X chromosome.

If a woman carries the abnormal gene on one of her X chromosomes (females have a pair of X chromosomes), she will not have hemophilia herself, but she will be a carrier of the disorder. That means that she can pass the gene for hemophilia on to her children. There is a 50% chance that any of her sons will inherit the gene and will be born with hemophilia. There is also a 50% chance that any of her daughters will be carriers of the gene without having hemophilia themselves.

It is very rare for a girl to be born with hemophilia, but it can happen if the father has hemophilia and the mother carries the gene for hemophilia. The daughter will then have the abnormal gene on both of her X chromosomes.

In about 20% of all cases of hemophilia, the disorder is caused by a spontaneous gene mutation. In such cases there is no family history of abnormal bleeding.

What are the symptoms of hemophilia?

The major symptom is bleeding, either prolonged external bleeding or bruising after minor trauma or for no apparent reason. Symptoms vary depending on whether the patient has the mild, moderate, or severe form of the disorder:

• In severe hemophilia, unprovoked (spontaneous) bleeding episodes occur often.
• In moderate hemophilia, prolonged bleeding tends to occur after a more significant injury.
• In mild hemophilia, a patient might have unusual bleeding, but only after a major injury, surgery, or trauma.

People with hemophilia may have any type of internal bleeding, but most often it occurs in the muscles and joints, such as the elbows, knees, hips, shoulders and ankles. There may be no pain at first, but if the bleeding continues, the joint may become hot to the touch, swollen, and painful to move.

Repeated bleeding into the joints and muscles over time may cause permanent damage, such as joint deformity and reduced mobility.

Bleeding in the brain is a very serious problem for those with severe hemophilia. It may be life-threatening. Get medical help immediately if you have signs of bleeding, such as:

• Changes in behavior.
• Excessive sleepiness.
• Headache that will not go away.
• Neck pain.
• Double vision.
• Vomiting.
• Convulsions or seizures.

Diagnosis and Tests

How is hemophilia diagnosed?

Your doctor will perform a physical examination to rule out other conditions. If you have symptoms of hemophilia, the provider will ask about your family’s medical history since this disorder tends to run in families. In children with severe hemophilia, the diagnosis is usually made in infancy. This might happen at the time of circumcision or when the toddler starts to walk and develops excessive bleeding or bruising with minor trauma.

Blood tests are then performed to determine how much factor VIII or factor IX is present. These tests will show which type of hemophilia you have and whether it is mild, moderate, or severe, depending on the level of clotting factor in the blood:

• People who have 5%-30% of the normal amount of clotting factors in their blood have mild hemophilia.
• People with 1%-5% of the normal level of clotting factors have moderate hemophilia.
• People with less than 1% of the normal clotting factors have severe hemophilia.

Your doctor may request that other family members have a Factor VIII level drawn to determine if they are affected. In some cases genetic testing may be necessary.

Management and Treatment

How is hemophilia treated?

Treatment depends on the type and severity of the disorder. It consists of replacement therapy, in which human plasma concentrates or recombinant (produced from DNA) forms of the clotting factors VIII or IX are given to replace the blood clotting factors that are missing or deficient.

• Blood factor concentrates are made from donated human blood that has been treated and screened to reduce the risk of transmitting infectious diseases, such as hepatitis and HIV.
• Recombinant clotting factors, which are made in the laboratory and not from human blood, are commonly used today.
• Recombinant FVIII and FIX products, modified to survive longer in the circulation, are now available. They required less frequent dosing for prophylaxis or prevention of bleeding.
• Newer non-factor products are also being developed for prophylactic use in hemophilia. These have the advantage of much less frequent administration, and in some cases do not require intravenous administration.

During replacement therapy, the clotting factors are injected or infused (dripped) into a patient’s vein in the arm or a port in the chest. Usually, people with mild or moderate hemophilia do not need replacement therapy unless they are going to have surgery.

• In cases of severe hemophilia, treatment may be given to stop bleeding when it occurs. Patients who have frequent bleeding episodes may be candidates for prophylactic factor infusions. These are given two or three times per week to prevent bleeding from occurring.
• Some people with the mild or moderate form of hemophilia type A can be treated with desmopressin (DDAVP®), a synthetic (man-made) hormone that helps to stimulate the release of factor VIII and another blood factor that carries and binds to it. Sometimes desmopressin is given as a preventive measure before a person with hemophilia has dental work or some other minor surgical procedure. Desmopressin does not work for people with type B hemophilia or severe hemophilia A.
• Aminocaproic acid or tranexamic acid are agents that prevent clots from breaking down (“antifibrinolytics”). They may be used as an added therapy to treat nosebleeds or bleeding from having a tooth removed.

The only absolute cure for hemophilia is a liver transplant. However, much progress is being made in finding a genetic cure for persons with hemophilia.

Are there complications related to hemophilia treatment?

People with hemophilia who are treated with either plasma-purified or recombinant factor products may develop antibodies, called inhibitors, which will attack and neutralize their clotting factor. This is a severe complication that makes it very difficult to treat or prevent bleeding episodes. About one-third to one-fifth of people who have severe hemophilia A might develop an inhibitor. Inhibitors are much less common in hemophilia B. Hemophilia patients are tested frequently for a factor inhibitor, especially in childhood when they are first starting replacement therapy.

If you have an inhibitor, there are alternative medications that can bypass its negative effect and successfully treat a bleeding episode. For long-term control, however, a technique called immune tolerance induction (or ITI) is used to bring down the level of the inhibitor and enable factor replacement to work again. The protocol consists of daily doses of clotting factors given over a period of time, weeks or even years in some cases. Some people may also get immune-suppressing drugs. ITI is successful in about 70% of people with hemophilia A, and 30% for hemophilia B. New agents, specifically for patients with inhibitors have been developed and are quite effective. Your healthcare provider will discuss these options with you.

Are there home treatments for bleeds in people with hemophilia?

In most cases a child with severe hemophilia is managed at home by his parents, with the administration of factor on a prophylactic schedule. As the child gets older, he is taught how to self-administer his factor on schedule or when an acute bleed occurs. At the time of a joint bleed, you can treat the pain using the “RICE” (Rest, Ice, Compression, Elevation) protocol.

Pain medications are limited in hemophilia because common pain relievers such as aspirin, ibuprofen and naproxen can aggravate bleeding. If you or your child is suffering from pain related to an injury, you can use acetaminophen (sold under the brand name Tylenol®).

Prevention

How can I prevent hemophilia?

You cannot prevent hemophilia. It is a genetic condition that is inherited from the maternal side of your family.

Outlook / Prognosis

What is the outlook for people with hemophilia?

People with hemophilia can expect to have a lifespan and lifestyle that is relatively normal, as long as they are educated about their condition and have adequate treatment. The outlook for people with inhibitors is less hopeful, especially for those who are considered high responders. (Their immune system is very active against the clotting factors.) However, with the new medications being developed for this patient group there is reason for optimism.

When should I contact the doctor if I have hemophilia or if my child has hemophilia?

After a head injury you should go to an emergency room immediately, especially if symptoms such as headache, weakness and vomiting develop. With head trauma, you or your child should not take any type of pain reliever until you are told to do so by your doctor.

You should also contact your doctor or go to the emergency room in the case of other injuries in which bleeding cannot be easily controlled with factor infusion and local measures.

Living With

What should you know about living with hemophilia?

Here are some general guidelines that might be helpful.

If your child has hemophilia, make sure school and babysitters understand special needs. Keep a first aid kit with you at all times. Minor cuts can usually be treated with gauze, pressure, and bandages. Raise the affected part of the body.

Remember—people with hemophilia should not take aspirin or ibuprofen. These medicines can interfere with blood clotting.

Make sure to get vaccines against hepatitis A and B to make sure clotting factors made from donated blood are even safer.

Finally, follow the recommendations that people who do not have hemophilia follow to maintain good health:

• Exercise regularly (swimming is particularly good).
• Eat healthy foods to maintain a healthy weight.
• Practice good dental hygiene.

Resources

Are there resources for people with hemophilia?

You may find this information to be helpful:

Severe Nosebleed Epistaxis – Causes & Treatment | Mount Sinai

Nosebleeds, also known as epistaxis, are common issues that usually resolve on their own or are easily treated in a medical environment. For some patients, nosebleeds can be severe enough that further treatments are needed. At Mount Sinai, we have experience handling these cases of epistaxis.

Severe episodes of nosebleeds can be caused by:

• Hereditary hemorrhagic telangiectasia (HHT), also known as Osler Weber Rendu syndrome, is a genetically inherited condition. People with HHT have small blood vessel malformations, known as telangiectasias, which affect the skin and mucosal membranes. Nosebleeds are the most common symptom; between 50 percent and 80 percent have recurrent bleeds.
• Spontaneous epistaxis usually occurs in the fifth decade of life, and may be associated with hypertension or liver insufficiency. This type of nosebleed resolves without medical treatment; however, in some patients, the intensity or repetition of hemorrhages in a short period of time may require more invasive nosebleed treatment such as embolization.
• Trauma
• Tumors Occasionally bleeding from the nasal or oral cavities may be related to the presence of a tumor. If there is concern for this, further imaging such as computer tomography scan or magnetic resonance imaging to evaluate what is happening.
• Vascular Malformations

Treatment Options

The first step in managing a severe nosebleed involves “packing” the nose, which should be performed by an appropriately trained physician. If this does not stop the bleeding, a procedure called embolization is performed by which the blood vessel supplying the inner lining of the nose is blocked.

If you experience severe blood loss from a nosebleed, it can cause serious anemia or cardiac dysfunction and reduced quality of life. At Mount Sinai, we can use embolization to treat severe, recurring nosebleeds that cannot be controlled by traditional means.

We may investigate the source of the bleeding via angiography. After we identify the vessels responsible for the bleeding, we can go back in through a catheter and block the vessels to stop the bleeding (embolization). In some cases, this technique can be lifesaving.

Causes, Prevention and How to Treat

Most nosebleeds are a nuisance and stop within 5 to 10 minutes. They usually do not cause enough blood loss to be serious in children who are otherwise healthy. Nosebleeds are common in children because delicate, small blood vessels line the nose and can easily break.

What Causes Nosebleeds

Nosebleeds are most often caused by:

• nose picking or scratching the inside of the nose
• rubbing the nose often
• dry air – Home heating systems may dry the air in your home and also dry the lining of the nose.
• getting hit in the nose or putting an object inside it
• blowing too hard
• colds or allergies
• abnormal tissue (skin) growth inside, such as polyps

Frequent nosebleeds within a few days are usually from the spot where a clot has formed and then comes off.

How to Stop a Nosebleed

Here are a few things you can help your child do to stop a nosebleed. Tell your child to:

• Try to be quiet and calm. Talking, laughing or crying may cause more bleeding.
• Sit up and lean the head forward slightly (Picture 1). Do not lie down, lean back or put their head between their knees.
• Pinch the nostrils tightly closed at the soft part of the nose just below the nasal bone (bone at the top of the nose). For young children, you might need to do this for them.
• Breathe through the mouth.
• Hold the nostrils closed for 5 minutes. Time this with a clock or watch. If the bleeding has not stopped after a full 5 minutes, hold the nostrils closed for 5 more minutes. Call your child’s health care provider if bleeding does not stop after a total of 10 minutes of pinching the nostrils.
• Wet a washcloth or hand towel with cool water. Wring it out and press firmly to the nose and cheeks.
• Do not blow the nose or remove crusts for several hours. If your child needs to blow their nose, remind them to do it very gently. Blowing or wiping the nose may cause the bleeding to start again.
• Spit out any blood that collects in the mouth. Swallowing a large amount of blood may cause your child to have a stomachache or vomit (throw up).

How to Help Prevent Nosebleeds

• Fingernails should be cut short to prevent scratching the inside of the nose.
• Keep fingers and objects out of the nose. Avoid rubbing the nose.
• Teach your child to blow their nose gently.
• Use a cool vaporizer or a humidifier in your child’s bedroom at night, especially during the winter. Be sure to clean the machine once a week.
• Smear a very thin coat of nasal ointment inside each nostril 2 to 3 times a day, especially at bedtime, for 2 weeks during the dry season. Petroleum jelly ointments, such as Vaseline® or Aquaphor® work best. This will keep the lining of the nose moist.
• For colds or a stuffy nose, use a saline nose spray – 2 sprays to each nostril, 2 or more times a day.

More About Nosebleeds

• If your child takes aspirin, an anticoagulant (anti-clotting) medicine or uses nasal sprays for allergies, be sure to tell the health care provider how often the nosebleeds happen.

Call Your Child’s Health Care Provider If:

• The nosebleed does not stop after 10 minutes of pressure.
• Your child:
  • has a nosebleed after an accident or being hit in the face.
  • has a clotting disorder, blood in their urine or bruises easily.
  • becomes dizzy, pale or has any problems breathing.

Nosebleeds (PDF)

HH-I-84 ©1979, Revised 2021, Nationwide Children’s Hospital

Nosebleeds – Symptoms, Causes, Treatments

A nosebleed occurs when the tissue lining of the nose breaks and blood is released. This tissue contains small blood vessels, called arterioles, which can rupture easily. A nosebleed is medically known as epistaxis. Nosebleeds are very common, and children between the ages of two and 10 and adults between 50 and 80 years seem to be most susceptible.

The most common nosebleeds happen in the front (anterior) of the nose. Anterior nosebleeds flow down and out of the nose. These nosebleeds generally occur in the septum, which divides the nostrils. Anterior nosebleeds are most frequently caused by some type of trauma. The blood vessels in the septum can be broken by scratching with a fingernail or during a high-impact injury to the nose. Dry air can cause the septum lining to dry out and crack, which may also cause a nosebleed in the anterior of the nose.

Anterior nosebleeds can be stopped by sitting upright to ensure that your head is higher than your heart. Breathe through your mouth instead of your nose and lean forward slightly to avoid swallowing blood. Using your thumb and index finger, gently pinch the soft fleshy part of your nose closed for 15 minutes.

Nosebleeds in the back (posterior) of the nose are less common and potentially more dangerous. Posterior nosebleeds occur higher and deeper in the nose, causing blood to flow down the throat. A posterior nosebleed can also result from a blow to the face or nose. Stopping a posterior nosebleed may require the assistance of a health care provider.

Frequent nosebleeds may be a symptom of a blood clotting disorder that is present from birth and should be discussed with your health care provider.

Seek immediate medical care (call 911) for a nosebleed that occurs after a head injury, if the nosebleed lasts longer than 30 minutes, if you are vomiting blood or having difficulty breathing, or if you experience confusion or loss of consciousness even for a brief moment.

Seek prompt medical care if you have recurring nosebleeds.

Epistaxis (nosebleed) – CIRSE

Overview

Nosebleeds are a very common medical problem. They generally result when the tissue that lines part of the nose erodes and certain vessels become exposed and break.

Causes include trauma, abnormalities in the structure that separates the nose into two sides (septum), irritation of the tissue lining the nasal cavity, inflammatory diseases, tumours, high blood pressure, vitamin K deficiency, hardening of arteries (arteriosclerosis) and specific blood or blood vessel disorders (such as hereditary haemorrhagic telangiectasia).

There are two types of nose bleeding: posterior and anterior. Anterior bleeds come from the front of the nose, and are more frequent. Posterior bleeds come from the back of the nose. These are usually heavier and more difficult to control. They are more frequently associated with complications such as airway obstruction, breathing blood into the lungs and coughing it up, and abnormally low blood plasma volume.

Most episodes of nosebleeds are self-limited, meaning the bleeding will stop without medical assistance. In rare cases, nosebleeds can be life-threatening, especially in elderly patients and those who suffer from diseases or conditions that occur together with the nosebleeds.

Symptoms

In most cases, blood will flow from a single nostril, but when a nosebleed is particularly heavy, it will spill into the second nostril, and may also run down the throat and into the stomach (in which case the patient will also spit up or vomit blood). In rare cases, where blood loss is especially heavy, the patient may feel light-headed, dizzy and may even faint.

Diagnosis

Episodes of nose bleeding are self-evident. Where they are especially severe or recur, it is necessary to see a doctor. Lab tests will allow the doctor to evaluate underlying medical conditions that may be causing the severe bleeding.

Treatment

Most nosebleeds can be self-treated by directly applying manual pressure to the nostrils, squeezing them between the fingers for 5 to 30 minutes. The head should be elevated, but not pushed too far back (in order to avoid swallowing blood).

If the vessel that is causing the bleeding is one that is easily seen and accessed, the doctor can seal it with a procedure called cauterisation. If the bleeding does not respond to cauterisation, nasal packing is an option. This involves placing an intra-nasal device, such as gauze, a type of balloon or sponge, to apply constant pressure. Nasal saline sprays may be useful for bleeding caused by excessive dryness.

Where bleeding is severe and recurring, medications are available to control the pain and to treat conditions causing the bleeds, such as vitamin K deficiency and high blood pressure. Antibiotics may be necessary to prevent infection.

Where severe nosebleeds keep occurring, surgery may be an option, such as arterial ligation. In this procedure, a doctor will tie up the specific blood veins causing the nosebleeds, preventing them from bleeding. This may require local or general anaesthesia.

Some patients may not qualify for surgery, or surgery may not work. For those patients, embolisation, a minimally invasive procedure that requires local anaesthesia only, may be an alternative. This involves making a small cut, inserting a catheter into a peripheral artery, and using image guidance to move it to the vessels that lead to the point of the bleeding. The specialist will then use one of several materials, such as liquid tissue glue, microcoils, beads or particles, to block the bleeding vessel.

The specialist will also perform an angiography (using contrast material and X-ray to see how the blood is flowing through the arteries) both before and after the procedure.

Bibliography

1. Moreau S, De Rugy MG, Babin E, Courtheoux P, Valdazo A. Supraselective embolization in intractable epistaxis: review of 45 cases. Laryngoscope. Jun 1998; 108(6):887-8.
2. Abelson TI. Epistaxis. In: Schaefer SD. Rhinology and Sinus Disease 1st ed. New York: Mosby; 1998:43-50.

Nosebleeds | UCI Health Otolaryngology | Ear, Nose and Throat | UCI Health

Nosebleeds (epistaxis) are very common. So common, in fact, that almost everyone in the world has at least one episode during their lifetime.

Causes

Successful management of epistaxis is highly dependent on the underlying cause. After any sudden bleeding is controlled, all efforts should be directed at determining why it happened.

Several factors increase an individual’s risk of bleeding that should be considered and controlled, if possible:

• Nasal dryness. Caused by weather, home environment, nasal sprays.
• Inflammation. Including sinusitis, granulomatous disease (sarcoidosis, Wegener’s granulomatosis, rhinoscleroma, tuberculosis, syphilis).
• Trauma. Self-induced from nose picking (typically young children), facial or nasal trauma, or surgery.
• Tumors. Benign and malignant (cancer).
• Septal abnormalities. Including spurs, deviations or perforations, which may disrupt normal airflow, resulting in local turbulence and persistent damage to the nasal lining.
• High blood pressure. Results in changes in blood vessel walls that both cause them to bleed more easily and have a more difficult time healing to stop bleeds.
• Clotting disorders. Suggested by family history, easy bruising, or prolonged bleeding from prior minor injuries or surgery.
• Blood thinning medications. Including Plavix, aspirin and NSAIDs.
• Chemotherapy. Decreases body’s ability to manufacture new platelets.
• Severe malnutrition. Insufficient protein or vitamin K can result in deficiencies of clotting factors.
• Liver disease. Clotting factors are produced in the liver
• Kidney disease. Elevated blood urea nitrogen (BUN) is a platelet inhibitor
• Hereditary hemorrhagic telangiectasia (Osler-Weber-Rendu disease). An inherited disorder involving formation of abnormal blood vessels that have very thin walls. These are easily damaged with even minor trauma and tend to briskly bleed.

Minor nosebleeds may be of little consequence. When they are frequent they can be a significant annoyance. Inconvenience or fear of bleeding in public may lead to reduced quality of life or even self withdrawal.

When episodes are repeatedly heavy, blood transfusions may be necessary, particularly in elderly or already anemic patients who cannot tolerate much blood loss.

Management

In select cases, office evaluation and management of active or recurrent bleeding is effective.

Nasal endoscopy can help determine where the bleeding is coming from. It can also find abnormalities such as inflammation, septal problems and tumors. When bleeding is exclusively from one side, the presence of a tumor should be excluded.

Management options can include any combination of moisturization, cautery and packing. Some forms of packing are absorbable, meaning they do not have to be removed. Any nasal procedure is performed with topical anesthesia for comfort.

If these measures don’t improve the bleeding, you may benefit from a minimally invasive procedure to reduce the majority of blood supply to areas of the nose that frequently bleed. This procedure is termed “sphenopalatine artery ligation” and is done under endoscopic visualization.

What to do

If you have a nosebleed:

• Try not to panic.
• Sit upright in a chair and lean forward. Apply pressure by pinching both sides of the entire soft part of your nose. Pinching the bone won’t help.
• Spray an over-the-counter decongestant before applying pressure. This will shrink the blood vessels and help slow or stop the bleeding.
• Hold pressure for at least 10 to 20 minutes.
• If bleeding persists after pressure, or seems too heavy and continuous at any time, call your physician’s office, an urgent care clinic, or plan to go to the emergency room.

For more information about our services, please call us at 714-456-7017 or request an appointment online ›

Nose Bleed in Cats – Symptoms, Causes, Diagnosis, Treatment, Recovery, Management, Cost

The treatment for epistaxis will depend on the underlying cause. Treatments may range from simple measures to stop the bleeding to prescription medications or more invasive measures like surgery or blood transfusions. If your pet experiences nosebleeds at home, do not attempt to provide them with any medication unless advised to do so by a veterinarian, as this could cause serious complications. The following treatment methods are commonly used to treat nosebleeds in cats:

Icing & Pressure

Ice or a cold compress, applied to the nose and face, may be used to stop bleeding and treat any facial swelling. This is a common practice for nosebleeds caused by injury or inflammation. If icing does not stop the bleeding, the nasal cavity may be packed with gauze to provide pressure and decrease blood flow.  

Antibiotics or Other Medications 

If an infection is the cause of the nosebleeds, medication may be prescribed to clear up the infection. Antibiotics, antifungals, or parasite eliminating medications will be used depending on the source of the infection. Proper dosing is needed to reduce the risk of side effects. 

Intravenous (IV) Fluids 

Fluid therapy is often used for animals experiencing weakness or lethargy. They help maintain proper hydration and can aid in restoring electrolyte balance. This common treatment is considered low-risk. 

Blood Pressure or Anxiety Medications 

Drugs may be used to reduce blood pressure and lower stress levels as these conditions can increase nosebleed risk. This medication may be prescribed for use on a long-term basis if blood pressure or anxiety is determined to be the cause. 

Surgical Intervention

Surgery to remove an object or tumor, to repair damage, or to surgically cauterize blood vessels may be needed. Any surgical procedure carries some risk. Your pet will likely be hospitalized during recovery. 

Blood Transfusion 

If blood disorders are present or anemia is severe, a blood or plasma transfusion may be required. Proper blood typing and adherence to transfusion protocol will help reduce the risks associated with this form of treatment.

90,000 Nosebleeds: symptoms, diagnosis, treatment of nosebleeds

Almost everyone has experienced nosebleeds. And if someone had single episodes during their life that did not require special treatment, and passed without a trace, then there are people for whom this becomes a serious, exciting problem. Recurrent nosebleeds very quickly change the usual way of life, the patient waits for each bleeding with excitement and fear, not knowing when and where it will happen, how long it will last, how the surrounding people will react.A person, as it were, adjusts to his illness, becomes withdrawn, sedentary, sees a connection with the disease in many actions, is afraid of active entertainment.
The causes of recurrent nosebleeds are both local and general factors, and most often their combination. Most often (about 80%), the place of bleeding is in the area of ​​the so-called. Kisselbach’s place is a zone located in the anterior sections of the nasal septum, a feature of which is the presence of a developed vascular network located close to the surface of the mucous membrane, as well as susceptibility to mechanical stress. The remaining 20% ​​are distributed throughout the nasal cavity, but the most dangerous are bleeding from the posterior sections, where the branches of rather large ethmoid arteries are located.

There are a great many reasons for the development of nosebleeds: diseases of the nasal mucosa (atrophic rhinitis, dry perforated rhinitis), benign neoplasms of vascular origin (hemangiomas, angiofibroma), malignant neoplasms; common causes are hypertension, disruption of the coagulation system, systemic diseases, and many others.

At the initial visit, not only examination of an ENT specialist is necessary, but also a thorough general examination. Treatment of nosebleeds consists of correction of systemic disorders and local treatment, which is divided into surgical and therapeutic methods. Local treatment is aimed at improving the functional state and regeneration of the mucous membrane, reducing the permeability and “fragility” of blood vessels, the use of drugs with a hemostatic effect. Surgical treatment is reduced to high-frequency exposure to current aimed at coagulation of the bleeding vessel; the method of separating the mucous membrane in the bleeding zone is more effective.

Successful treatment is possible only with the maximum correction of all identified factors and allows the patient to return to a normal lifestyle and feel like a healthy person. The treatment sometimes requires the participation of several specialists: an otolaryngologist, therapist, hematologist, endocrinologist, rheumatologist

Epistaxis | Polyclinic Otradnoe

Epistaxis: Causes in adults and children

The reasons are classified as local and general.Local processes include processes occurring directly inside the nasal cavity:

• Any injury to the nose, its mucous membrane and intranasal structures, including injuries caused by surgical or other medical intervention and foreign bodies, head injuries.
• Dystrophic changes in the mucous membrane: curvature of the nasal septum, atrophic rhinitis.
• Neoplasms inside the nasopharynx: granulomas, tumors, angiomas, sarcomas, papillomas, etc.d.
• Inflammatory processes due to hyperemia (overcrowding) of the mucous membrane: sinusitis, rhinitis.
• Dryness of the nasopharyngeal mucosa due to insufficient air humidity.
• Inhalation of substances that irritate the nasal mucosa.

Common causes of nosebleeds:

• Cardiovascular pathologies: hypertension, atherosclerosis, heart and vascular defects.
• Significant increase in body temperature due to overheating of the body, sunstroke, infections.
• Hereditary and acquired blood diseases (especially those associated with impaired blood clotting).
• Intoxication of the body (including alcoholic).
• Lack or excess of vitamins in the body.
• Overdose of anticoagulants (blood thinners).
• Endocrine pathologies: hypothyroidism (lack of thyroid hormones), hypoestrogenism (deficiency of female sex hormones – estrogens).
• Diseases of the liver and kidneys.
• Physical overvoltage.
• Hormonal disorders or hormonal natural changes in the body (for example, nosebleeds are often observed in pregnant women and adolescents during puberty).
• Changes in the body due to changes in barometric pressure (occur in people engaged in scuba diving or mountaineering, flying by plane or helicopter).

Help! In 25-50% of cases, bleeding occurs for local reasons, in other cases – for general reasons.

Classification of nosebleeds

Bleeding is classified by location and frequency. They can occur:

• In the nasal cavity.
• Outside the nasal cavity (in the nasopharynx, paranasal sinuses, intracranial vessels).

Also, according to localization, the following varieties are distinguished:

• Anterior – the source of bleeding is located above the middle turbinate (an outgrowth on the side wall of the nasal cavity, covering the outflow openings of the maxillary and frontal sinuses).
• Posterior – the source is located below the middle turbinate.

Anterior nosebleeds in most cases do not differ in particular intensity, do not pose a threat to health or life. In the absence of blood diseases and vascular pathologies, they usually stop on their own or with minimal first aid measures. With anterior bleeding in a patient, blood flows out of the nostril (or both) in drops or trickle.

Posterior nosebleeds are intense, since large vessels are located in the deep parts of the nasal cavity, and significant blood loss is observed if their integrity is violated. They are capable of posing a danger to the health and even the life of the patient. Posterior bleeding is difficult to stop on your own, therefore, if it is present, you should immediately seek medical help! In this case, blood often does not flow out of the nose, but flows down the throat, entering the mouth and stomach. Posterior bleeding occurs much less frequently than the anterior one.

Help! The most common source of bleeding is the antero-inferior nasal cavity. This is due to anatomical features. In this area, there is a plexus of several layers of arterial and venous networks, which is easily damaged.

According to the frequency, the following types of bleeding are distinguished:

• Single.
• Recurrent.
• Habitual.

Help! Habitual bleeding is a bleeding that occurs several times a year.

Symptoms

The main symptom of nosebleeds – is the discharge of blood from the nostrils or its leakage into the mouth from the nasopharynx. However, depending on the blood loss, there are accompanying symptoms:

• Nausea.
• Coughing up blood.
• Pale skin.
• Weakness.
• Tinnitus.
• Thirst.
• Rapid heartbeat.
• Flashing flies before the eyes.
• Dizziness.

Help! With posterior bleeding, the patient may experience tarry stools, and if blood enters the stomach, vomiting interspersed with blood clots.

First Aid

In case of nosebleeds, the following measures should be taken:

1. Place the person on a chair so that their torso bends slightly forward.
2. Bleeding is best stopped with a cotton swab or gauze swab, moistened with water or 3% hydrogen peroxide solution, placed in the affected nostril and fixed with your fingers.
3. Before removal, the swab is moistened again with a pipette and then gently pulled out.
4. If there is no tampon at hand, and the bleeding is not caused by an injury to the nasal septum or a broken bone, then the wings of the nose may be gently pressed against the septum with the help of the thumb and forefinger and held for several minutes (no more than 5), while the victim must breathe through the mouth , and tilt your head forward slightly.
5. A cold compress or ice pack can be placed on the bridge of the nose for 10 – 15 minutes.
6. When the nosebleeds stop, you need to check if the blood is flowing down the throat: for this, the victim just needs to spit and see if there is blood in the saliva.

Not allowed:

• Place a person with nosebleeds on their back.
• Throw the victim’s head back.

Attention! If blood does not stop or posterior bleeding is observed, you should urgently visit a doctor or call an ambulance.

Diagnostics

Diagnostics is carried out in several stages:

• Taking anamnesis, which in most cases allows you to determine the cause of bleeding (trauma, arterial hypertension, etc.).
• Visual examination of the nose and its cavity, during which it is possible to establish the source of the pathology.
• Measurement of blood pressure.

Additional studies may be assigned:

• Complete blood count.
• Coagulogram (blood clotting test).
• Test for mechanical stability of capillaries.
• Study of the hemostasis system.

Differential diagnosis between epistaxis and gastric or pulmonary bleeding is also important.In this case, the color and consistency of the blood is studied. When it flows out of the lower respiratory tract, it is scarlet and foaming, and the bleeding is accompanied by a cough. With gastric bleeding, clotted blood, which has a dark color, is accompanied by vomiting with brown clots. Exactly the same vomiting is observed with posterior nosebleeds, if blood has entered the stomach. But in this case, there is also a runoff of scarlet blood along the back wall of the nasopharynx.

Treatment

If the blood cannot be stopped by pinching the wings of the nose with fingers or tamponade, the following procedures may be required:

• Electrocoagulation (“sealing” of vessels using electric current).
• Chemical moxibustion of vessels.

For severe nosebleeds that cannot be eliminated by conservative methods, surgery is performed. The operation is also prescribed if bleeding is caused by pathologies of the nasal septum – to prevent relapse.

In order to avoid relapses, it is important to eliminate the cause of the violations. If it is a blood clotting disorder, then hemostatics are prescribed – drugs that increase coagulability.If bleeding is caused by vitamin deficiency, the doctor selects vitamin and mineral complexes. If necessary, the patient is referred to a narrow specialist: cardiologist, endocrinologist, urologist, etc.

Prevention

It is certainly not possible to prevent any nosebleeds (especially when it comes to unexpected injuries), but you can minimize the risk of their occurrence. For this, it is necessary to timely treat all common pathologies and ENT diseases.If you have multiple recurring bleeding, you should see an otolaryngologist. Even if you easily coped with stopping the blood on your own, you should identify the cause of the pathology, and only a doctor can do this.

Also, preventive measures include regular moisturizing of the mucous membranes of the nasal membranes and indoor air. Avoid overheating, try not to inhale irritating substances.

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Polypoid sinusitis is a fairly common pathology of the upper respiratory tract.It is a chronic inflammatory disease of the mucous membrane of the nasal cavity and paranasal sinuses, characterized by the formation and recurrent growth of polyps, consisting mainly of edematous tissue infiltrated by eosinophils.

How it happens: the mucous membrane compensates for a chronic inflammatory process in the sinuses for a long time, and the patient may feel periodic or constant nasal congestion, mucous or purulent discharge, difficulty in nasal breathing.As the disease develops and the body continues to fight the infection, the depleted mucous membrane begins to grow, which, by increasing its area, is trying to fight the inflammatory process. If no treatment is carried out, then the process of proliferation of the mucous membrane gradually progresses, it goes beyond the sinus, i.e. into the nasal cavity.

Complaints of difficulty in nasal breathing appear at the very moment when part of the hyperplastic mucosa falls out of the sinus into the nasal cavity.The area of ​​the mucous membrane that extends beyond the sinus is the actual polyp. At the same time, the patient begins to pay attention to the fact that nasal breathing has deteriorated sharply, and to the fact that earlier, when using vasoconstrictor drops, nasal breathing quickly improved, and now the drops have stopped helping. If treatment is not applied at this stage, the process can lead to a complete loss of nasal breathing and smell, deterioration of general well-being, headache, tachycardia, and sleep disturbance.

Causes of polyps

– allergic diseases: allergic rhinitis, bronchial asthma, hay fever, etc.
– chronic inflammatory diseases of the paranasal sinuses: sinusitis, frontal sinusitis, ethmoiditis;
– pathological anatomical features of the structure of the nasal cavity: curvature of the nasal septum, hypertrophic rhinitis, narrowness of the nasal passages, etc.
– hereditary predisposition;
– intolerance to non-steroidal anti-inflammatory drugs (analgin, aspirin)
As a rule, there is no single cause.Polyps are formed as a result of a combination of several of the above reasons.

Complaints

– persistent difficulty in nasal breathing and nasal congestion;
– decrease or complete loss of smell;
– feeling of constant discomfort in the nose or sensation of a foreign body;
– with advanced polyposis, difficulty swallowing may appear when eating;
– headaches, or pain in the paranasal sinuses;
– Mucous or purulent nasal discharge.

Diagnostics

Polypoid sinusitis is diagnosed by otorhinolaryngological examination. When carrying out endoscopy of the nasal cavity, and this is the most effective diagnostic method – endoscopic diagnostics, which allows an examination with an increase in all details of the nasal structures and to the entire depth of the nose. The nasal endoscope allows you to examine the nasal cavity from different angles and accurately determine the presence of even the smallest neoplasms or growths of the mucous membrane.As a result, the shape, size and localization of neoplasms, as well as the degree of their distribution, are determined with precision. Information can be displayed on the monitor screen, photographed for subsequent tracking of the dynamics of treatment. An extensive allergological examination is also carried out.

A computed tomography scan of the paranasal sinuses is performed to determine how much the paranasal sinuses are affected. It is necessary for the doctor to determine the extent of the surgery.

Treatment

Nasal polyps are treated both conservatively and surgically. Each method has its own advantages and disadvantages. Practice shows that the most effective is an integrated approach, which consists in the surgical removal of polyps followed by a course of local conservative treatment. Surgical treatment consists of removing the polyps. It is fundamentally important to dwell on the methods of removing polyps. The most modern, effective and gentle method today is the so-called functional endoscopic endonasal surgery of the nasal cavity and paranasal sinuses (FESS) all over the world.With this method, using special endoscopic equipment, the surgeon is able to operate in all inaccessible and inaccessible parts of the nasal cavity and sinuses during conventional surgery. An important advantage of the method is that the sinus operation is performed through the nasal cavity – endonasally. This means that no incisions are made. Endoscopic surgery allows you to remove polyposis tissue from the sinuses directly through the natural openings of the latter, and the removal of polyps is performed using a special instrument – shaver or microdebrider , which works with millimeter accuracy within the healthy mucous membrane with minimal trauma to the latter.

Endoscopic technique allows you to control the entire course of the operation on the monitor screen, see the microstructures of the nose, significantly reduce the percentage of complications, and the use of self-expanding “breathing” tampons relieves patients from unpleasant sensations in the postoperative period.

Atraumatic and bloodless operations allow patients to quickly return to their usual rhythm of life. But the main thing is that the surgeon sees everything he does, and this ensures complete removal of polyps and creates the best conditions for further treatment with special inhalers, so that polyps do not grow again.

The most important point of postoperative treatment is the care of the nasal cavity, the ENT doctor performs the toilet of the nasal cavity, removal of crusts, mucus, with a large number of which the nasal cavity is washed with special solutions.

As already noted, the most effective combination treatment. First, the patient must undergo surgical treatment – endoscopic removal of polyps. After discharge from the hospital, the patient is prescribed a course of local corticosteroid therapy.For this, metered-dose inhalers are used to irrigate the nasal cavity. One of the best drugs in this group is Nasonex, which is prescribed for a period of at least 3 months after surgery. The patient continues to be monitored by an otorhinolaryngologist.

Treatment of nosebleeds | Medical center No. 1 Lipetsk

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Nasal bleeding (epistaxis ) is the discharge of blood from the nasal cavity that occurs when the vascular wall is damaged.It can be weak or profuse, which can pose a serious threat to human health and life.

Bleeding from the nose can be of two types, depending on the location of the lesion:

• From the anterior parts of the nasal cavity. Small blood vessels are at risk and their integrity is compromised. Usually, this bleeding stops by itself and does not cause much harm.
• From the back sections. In this case, we are talking about trauma to large vessels located in the deep-lying parts of the nose.The bleeding blood has a scarlet color and cannot stop on its own.

Sometimes blood loss is so profuse that a person needs emergency medical help. If bleeding has opened in the posterior half of the nose (turbinates, bony section of the nasal septum), then you need to see a doctor as soon as possible. More often, such a pathology occurs with blood diseases, atherosclerosis, after surgical interventions on the nasopharynx or nose.

Symptoms

In a patient with nosebleeds of the anterior parts of the nasal cavity, blood begins to flow from one or both nostrils in a stream or drops.There are usually no other symptoms.

Posterior nosebleeds are much more dangerous. In this case, blood begins to drain down the throat, resulting in nausea, hemoptysis, and later – tarry stools. The clinical picture of the pathology depends on the volume of blood lost. If it is significant, the patient may develop weakness and thirst, there may be tinnitus and heart palpitations, dizziness and flashing before the eyes of flies. Also, the skin and mucous membranes turn pale.With large blood loss, there is a risk of hemorrhagic shock.

Fainting is possible in people with pathological fear of blood.

Causes of nosebleeds

Nosebleeds can have many causes. The most common ones include:

• injuries to the nose and head;
• operations on the nasal cavity;
• various neoplasms in the nose;
• respiratory system infections;
• Inhalation of dry or polluted air.

Systemic diseases, liver diseases, rhinitis, arteriosclerosis, perforation of the nasal septum, coagulopathy, history of foreign bodies entering the nasal cavity, etc. thorough analysis of complaints. It is necessary to find out if the patient has any diseases or conditions that can provoke nosebleeds. Blood pressure is measured without fail in order to exclude hypertension.It is clarified whether the patient is taking drugs that can cause the pathology in question.

In case of systematic bleeding from the nose, the ENT performs rhinoscopy and pharyngoscopy. Endoscopic examination of the nasal cavity is also considered informative.

Laboratory diagnostic methods can also be used. For example, OAC and coagulogram are very often performed.

Treatment of nosebleeds in Lipetsk

Nosebleeds can be characterized by different treatment approaches.It all depends on the nature, cause and characteristics of the pathology. With significant blood loss, it is important to compensate for them. In order to prevent relapses, the efforts of specialists are aimed at eliminating the underlying disease that provokes the problem.

The Medical and Diagnostic Center No. 1 in Lipetsk knows how to help a patient with nosebleeds. To do this, experienced ENT doctors take into account many factors that allow them to quickly develop competent treatment tactics.

Lor in Lipetsk: +7 (4742) 37-02-52, +7 (4742) 37-03-52, +7 (4742) 37-04-52, you can also sign up online

reasons, symptoms, diagnostics, treatment, prevention

It is a pathological condition caused by the release of blood from the nasal cavity.With this violation, blood can flow out of the nostrils or flow down the throat.

Causes

Nasal bleeding can occur due to local causes such as trauma to the nose, traumatic head injuries, respiratory infections, surgical interventions in the nasal cavity, the development of polyps or other neoplasms in the nasal cavity, inhalation of irritants or insufficient humidity.

The main reasons contributing to the development of nosebleeds include arterial hypertension, in particular hypertensive crisis, hemostasis disorders, inflammatory vascular diseases, some blood diseases, systemic infectious diseases.

Symptoms

When anterior nosebleeds occur, the patient is observed to leak blood from one or both nostrils in drops or a stream. Posterior nosebleeds may not be accompanied by obvious signs. With this type of ailment, blood flows down the throat, as a result of which, over time, nausea, hemoptysis, and tarry stools may appear. The clinical picture of nosebleeds depends on the amount of blood loss. With insignificant blood loss, the general condition of the patient does not change.Patients with pathological fear of blood may faint. With prolonged nosebleeds, weakness, flashing of flies before the eyes, tinnitus, heart palpitations, dizziness, thirst, pallor of visible mucous membranes and skin may appear. With massive blood loss, the development of hemorrhagic shock can be observed.

Diagnostics

When diagnosing nosebleeds, an analysis of complaints and anamnesis of the disease is carried out. You will also need to find out if the patient has diseases that contribute to the development of this disorder.In such patients, blood pressure measurements are taken to rule out hypertension. It is also investigated whether the patient regularly takes any medications that can cause nosebleeds.

If the patient systematically develops bleeding from the nose, he is prescribed rhinoscopy, pharyngoscopy. In some cases, an endoscopic examination of the nasal cavity may be required.

The patient can also be assigned a complete blood count and coagulogram.

Treatment

At the initial stage, nosebleeds are stopped. When choosing a therapy regimen, treatment is aimed at eliminating the underlying disease, preventing the patient from developing relapses and, if necessary, compensating for blood loss.

First aid for minor anterior bleeding is based on lightly pressing the wings of the nose against the nasal septum with fingers, applying a cold compress or ice to the nose, possibly introducing a cotton swab moistened with a vasoconstrictor into the bleeding nostril.If necessary, it may be necessary to carry out a tight tamponade of the nose, cauterization of a bleeding vessel with chemicals, cauterization of a bleeding vessel with an electrocoagulator, the use of drugs that increase blood clotting, hemostatics. Surgical stopping is carried out for severe nosebleeds that cannot be stopped using conservative methods.

Prevention

Prevention of the development of nosebleeds includes high-quality humidification of the air, moisturizing the nasal mucosa, preventing the development of injuries to the nose, head and inhalation of irritants.

Nosebleeds | ALM Medicine

The causes are varied: trauma, infectious diseases, blood diseases, arterial hypertension, liver cirrhosis, hypertrophy (enlargement) of the nasal mucosa, sinusitis (inflammation of the maxillary sinuses), benign vascular (angioma) or malignant tumor.

Trauma bleeding is the most understandable and understandable. Children have to look at their hands, because if you pick your nose, a red border of dried blood will be visible under the nail plates.First aid – insert a tampon with 3% hydrogen peroxide solution into the nasal cavity and press the wing against the septum. After 5 to 7 minutes, the bleeding should stop. If this does not happen, it is necessary to urgently consult an ENT doctor for an anterior nasal tamponade. If bleeding is profuse and prolonged, a posterior tamponade is placed. In any case, even if they themselves stopped the blood after injury, it is necessary to consult an ENT doctor in 3-4 days to exclude curvature or bone fracture.

Nosebleeds occur in acute infectious diseases that cause blood clotting disorders – with adenovirus infection, hemorrhagic fevers.Usually the condition is beyond doubt: fever, catarrhal phenomena (cough, runny nose, headache). Stop with a cotton swab moistened with 3% hydrogen peroxide solution, take antipyretic. In case of repeated bleeding, it is necessary to pass a clinical blood test with hemosyndrome and consult a hematologist.

In diseases of the blood, such as hemophilia A, von Willebrant disease, thrombocytopenia (deficiency of platelet-regulators of clotting), coagulopathy (violation of the blood coagulation system), nosebleeds often occur.In such cases, hydrogen peroxide is no longer enough. In a home medicine cabinet, you must have a hemostatic sponge or wipes moistened with aminocaproic acid. Observation and treatment of the underlying disease by a hematologist is mandatory.

With arterial hypertension in adults and vegetative-vascular dystonia of the hypertensive type, children and adolescents sometimes also have nosebleeds. They usually start with a headache that gradually worsens to unbearable. At the peak of the pain, bleeding opens, it is profuse, but short-term.After that, the pain goes away. It is necessary to treat the underlying disease by a therapist for adults and a pediatrician and neurologist for children and adolescents.

In case of nosebleeds of unknown etiology (unknown cause), first of all, you should visit an ENT doctor. On examination, you can understand the reason. This can be an inflammatory process in the maxillary sinuses, angioma (benign vascular tumor), dilated vessels of the Kisselbach zone (a bundle of vessels located on the surface of the nasal mucosa), hypertrophy (enlargement) of the membrane, malignant tumor.Depending on the cause of nosebleeds, ENT, the doctor prescribes conservative or surgical treatment.