Recurrent epistaxis in children: When should we suspect coagulopathy?

Wahaba, M. A. S., H. Fathy, R. Ismail, and N. Mahmoud, Recurrent epistaxis in children: When should we suspect coagulopathy?, , 2014.


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 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%).
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.