Skip to main content
The Egyptian Journal of Otolaryngology
Download PDF

Recurrent epistaxis in children: When should we suspect coagulopathy?

The Egyptian Journal of Otolaryngology volume 30, pages 106–111 (2014)Cite this article

En

Abstract

Objective

The objective of this study was to evaluate children and adolescents with recurrent epistaxis and to spot variables that may predict underlying bleeding disorder.

Study design

This was a prospective study.

Materials and methods

Thirty-six children with recurrent epistaxis were recruited from ENT outpatient clinic as well as emergency room of Cairo University children hospital. Patients with systemic causes for epistaxis were not included. All patients were subjected to basic workup to differentiate between ENT and hematological causes of epistaxis. Accordingly, extended ENT investigations or coagulation studies were performed.

Results

Results showed 47.6% incidence for bleeding disorders, 39.7% incidence for ENT causes, and 12.7% incidence for idiopathic causes. Reported coagulopathies included idiopathic thrombocytopenic purpura with an incidence of 26.7%, platelet functions disorders such as Glanzmann’s thrombasthenia (13.3%) and Bernard-Soulier syndrome (10%), aplastic anemia (3.3%), hemophilia A (3.3%), Von Willebrand disease (3.3%), and unclassified (40%). Reported local ENT causes included bacterial rhinitis (88%) (lodged foreign body was found in 1/3 of these patients, digital trauma by habitual nose picking was detected in another 1/3, and the remaining 1/3 represented cases of complicated previous viral rhinitis), nasal allergy (8%), and adenoid (4%).

Conclusion

The study recommended some statistically significant predictors for bleeding disorders such as positive consanguinity, high epistaxis bleeding score, presence of other bleeding sites, low hemoglobin level and platelet count, and elevated activated partial thromboplastin time.

References

  1. Pollice PA, Yoder MG. Epistaxis: a retrospective review of hospitalized patients. Otolaryngol Head Neck Surg 1997; 117: 49–53.

    Article  CAS  PubMed  Google Scholar 

  2. Thana MA, Nilssen ELK, Holland S, Love G, White PS. Routine coagulation screening in the management of emergency admission for epistaxis — is it necessary?. J Laryngol Otol 2000; 114: 38–40.

    Article  Google Scholar 

  3. Watkinson JC. In: Kerr AG, Mackay IS, Bull TR, editors. Epistaxis. Scott-Brown’s otolaryngology. 6th ed. Rhinology, Oxford: Butterworth-Heinemann; 1997. Vol. 4:1–19

    Google Scholar 

  4. Varshney S, Saxena RK. Epistaxis: a retrospective clinical study. Indian J Otolaryngol Head Neck Surg 2005; 57: 125–129.

    PubMed Central  PubMed  Google Scholar 

  5. Guarisco JL, Graham III HD. Epistaxis in children: causes, diagnosis, and treatment. Ear Nose Throat J 1989; 68: 528–530.

    Google Scholar 

  6. Katsanis E, Luke KH, Hsu E, Li M, Lillicrap D. Prevalence and significance of mild bleeding disorders in children with recurrent epistaxis. The Journal of pediatrics. J Pediatr. 1988; 113:73–6.

    Article  CAS  PubMed  Google Scholar 

  7. Hussain G, Iqbal M, Shah SA, Said M, Sanaullah, Khan SA, et al. Evaluation of aetiology and efficacy of management protocol of epistaxis. J Ayub Med Coll Abbottabad 2006; 18: 63–66.

    PubMed  Google Scholar 

  8. Sandoval C, Dong S, Visintainer P, Ozkaynak MF, Jayabose S. Clinical and laboratory features of 178 children with recurrent epistaxis. J Pediatr Hematol Oncol 2002; 24: 47–49.

    Article  PubMed  Google Scholar 

  9. Viljoen J. Epistaxis in children: approach and management. CME 2003; 21: 1–6.

    Google Scholar 

  10. Dizdar O, Ibrahim KO, Ozakin E, Karakilic E, Karadag O, Kalyoncu U, et al. Research for bleeding tendency in patients presenting with significant epistaxis. Blood Coagul Fibrinolysis 2007; 18:41–43.

    Article  CAS  PubMed  Google Scholar 

  11. Kubba H. Childhood epistaxis. Clin Otolaryngol 2006; 31:212–213.

    Article  CAS  PubMed  Google Scholar 

  12. Montague ML, Whymark A, Howatson A, Kubba H. The pathology of visible blood vessels on the nasal septum in management of epistaxis. J Indian Med Assoc 2010; 108:597–598.

    Google Scholar 

  13. Figueiredo RR, Azevedo AA, Kós AO, Tomita S. Nasal foreign bodies: description of types and complications in 420 cases. Braz J Otorhinolaryngol 2006; 72:18–23.

    Article  PubMed  Google Scholar 

  14. Ogunleye AO, Sogebi OA. Nasal foreign bodies in the African children. Afr J Med Med Sci 2004; 33:225–228.

    CAS  PubMed  Google Scholar 

  15. Ahmad N, Zacharek MA. Allergic rhinitis and rhinosinusitis. Otolaryngol Clin North Am 2008; 41:267–281.

    Article  PubMed  Google Scholar 

  16. Deshazo RD, Swain RE. Diagnostic criteria for allergic fungal sinusitis. J Allergy Clin Immunol 1995; 96:24–35.

    Article  CAS  PubMed  Google Scholar 

  17. Chandra J, Ravi R, Singh V, Narayan S, Sharma S, Dutta AK. Bleeding manifestations in severely thrombocytopenic children with immune thrombocytopenic purpra. Hematology 2006; 11:131–133.

    Article  PubMed  Google Scholar 

  18. Sidonia RF Jr, Gunawardena S, Shaw PH, Ragni M. Predictors of von Willebrand disease in children. Pediatr Blood Cancer 2012; 58:736–740.

    Article  Google Scholar 

  19. Mokhtar GM, Tantawy AA, Adly AA, Telbany MA, Arab SE, Ismail M. A longitudinal prospective study of bleeding diathesis in Egyptian pediatric patients: single-center experience. Blood Coagul Fibrinolysis 2012; 23:411–418.

    Article  PubMed  Google Scholar 

  20. El-Bostany EA, Omer N, Salama EE, El-Ghoroury EA, Al-Jaouni SK. The spectrum of inherited bleeding disorders in pediatrics. Blood Coagul Fibrinolysis 2008; 19:771–775.

    Article  PubMed  Google Scholar 

  21. Tosetto A, Castaman G, Rodeghiero F. Bleeding scores in inherited bleeding disorders: clinical or research tools?. Haemophilia 2008; 14:415–422.

    Article  CAS  PubMed  Google Scholar 

  22. Kadir RA, Economides DL, Sabin CA, Owens D, Lee CA. Frequency of inherited bleeding disorders in women with menorrhagia. Lancet 1998; 351:485–489.

    Article  CAS  PubMed  Google Scholar 

  23. Jayasinghe Y, Moore P, Donath S, Campbell J, Monagle P, Grover S. Bleeding disorders in teenagers presenting with menorrhagia. Aust N Z J Obstet Gynaecol 2005; 45:439–443.

    Article  PubMed  Google Scholar 

  24. Elden L, Reinders M, Witmer C. Predictors of bleeding disorders in children with epistaxis: value of preoperative tests and clinical screening. Int J Pediatr Otorhinolaryngol 2012; 76:767–771.

    Article  PubMed  Google Scholar 

  25. Shaw PH, Reynolds S, Gunawardena S, Krishnamurti L, Ritchey AK. The prevalence of bleeding disorders among healthy pediatric patients with abnormal preprocedural coagulation studies. J Pediatr Hematol Oncol 2008; 30:135–141.

    Article  PubMed  Google Scholar 

  26. Damrose JF, Maddalozzo J. Pediatric epistaxis. Laryngoscope 2006; 116:387–393.

    Article  PubMed  Google Scholar 

  27. Gerlinger I, Torok L, Nagy A, Patzko A, Losonczy H, Pytel J. Frequency of coagulopathies in cases with post-tonsillectomy bleeding. Orv Hetil 2008; 149:441–446.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Pediatrics, Kasr El Aini University Hospital, Cairo University, Cairo, Egypt

    Magy S. Abdel Wahab & Rania Ismail

  2. Department of Otolaryngology Head and Neck Surgery, Kasr El Aini University Hospital, Cairo University, Cairo, Egypt

    Hesham Fathy

  3. Department of Pediatrics, Ministry of Health, Cairo, Egypt

    Nancy Mahmoud

Authors
  1. Magy S. Abdel Wahab
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hesham Fathy
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Rania Ismail
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Nancy Mahmoud
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hesham Fathy.

Additional information

Conflicts of interest

None declared.

Rights and permissions

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Abdel Wahab, M.S., Fathy, H., Ismail, R. et al. Recurrent epistaxis in children: When should we suspect coagulopathy?. Egypt J Otolaryngol 30, 106–111 (2014). https://doi.org/10.4103/1012-5574.133207

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.4103/1012-5574.133207

Keywords