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EPISTAXIS IN PEDIATRIC TERTIARY OUT-PATIENT CLINIC: COULD IT BE AN ALARMING SIGN?

PB1838

Elalfy, M.1; Tantawy, A.1; Eldin, Badr B.E.2; Ebeid, F.1; Mekawy, M. A.3; Mohammad, Y.1

doi: 10.1097/01.HS9.0000565856.30153.3c
Publication Only: Bleeding disorders (congenital and acquired)
Free

1Pediatric Department

2ENT

3Clinical Pathology, Ain Shams University, Faculty of Medicine, Cairo, Egypt

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Background:

Epistaxis could be an alarming bell to diagnose a hemostatic disorder.

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Aims:

To detect those with possible bleeding tendencies using simple tools of assessment.

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Methods:

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.

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Results:

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.

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Summary/Conclusion:

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.

Copyright © 2019 The Authors. Published by Wolters Kluwer Health Inc., on behalf of the European Hematology Association.