Publication Only: Bleeding disorders (congenital and acquired)
Epistaxis could be an alarming bell to diagnose a hemostatic disorder.
To detect those with possible bleeding tendencies using simple tools of assessment.
A prospective study for children attended tertiary pediatric out-patient clinic (POPC) over a one year; who had been presented with epistaxis of non-apparent cause. They underwent clinical assessment and parents answered pediatric bleeding questionnaire and epistaxis severity score. Complete blood count and coagulation profile, platelet function screening tests.
100 patients less than 18 years with epistaxis (53 females and 47 males), estimated annual frequency of epistaxis was 1 in 300 children attended Ain Shams University out-patient clinic. Half of them were younger than six years. 76 had recurrent epistaxis and 12 had systemic comorbidities. 90% presented by anterior nasal bleeding and the majority had been controlled just by nasal compression. 43 patients presented with epistaxis only; 15% had definite local cause, 85% of them were considered idiopathic on initial evaluation. 57 presented with other bleeding manifestations; 82% of them had a definite hemostatic disorder and ten percent needed further assessment. There was a positive family history for epistaxis in half of those with definite hemostatic disorders. A bleeding score of ≥2 showed significant value in suspecting hereditary hemostatic disorder as a cause of epistaxis.
Epistaxis as a presenting symptom to the POPC is not uncommon; the use of pediatric bleeding questionnaire was helpful to detect those with an underlying hemostatic disorder. Epistaxis was a presenting symptom for a hemostatic bleeding disorder in half of the referred cases. Still around 20% of epistaxis with suspected hemostatic disorder need further studies to reach a definite diagnosis.