Approach Considerations
For the most part, laboratory studies are not needed or helpful for first-time nosebleeds or infrequent recurrences with a good history of nose picking or trauma to the nose. However, they are recommended if major bleeding is present or if a coagulopathy is suspected.
Laboratory Tests
Laboratory tests to evaluate the patient’s condition and underlying medical problems may be ordered depending on the clinical picture at the time of presentation. If the bleeding is minor and not recurrent, then a laboratory evaluation may not be needed.
If a history of persistent heavy bleeding is present, obtain a hematocrit count and type and cross match. If a history of recurrent epistaxis, a platelet disorder, or neoplasia is present, obtain a complete blood count (CBC) with differential. The bleeding time is an excellent screening test if suspicion of a bleeding disorder is present. Obtain the international normalized ratio (INR)/prothrombin time (PT) if the patient is taking warfarin or if liver disease is suspected. Obtain the activated partial thromboplastin time (aPTT) as necessary.
Other Studies
Direct visualization with a good directed light source, a nasal speculum, and nasal suction should be sufficient in most patients. However, computed tomography (CT) scanning, magnetic resonance imaging (MRI), or both may be indicated to evaluate the surgical anatomy and to determine the presence and extent of rhinosinusitis, foreign bodies, and neoplasms. Nasopharyngoscopy may also be performed if a tumor is the suspected cause of bleeding.
Sinus films are rarely indicated for a nosebleed. Angiography is rarely indicated.
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Posterior epistaxis from the left sphenopalatine artery.
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Resolved posterior epistaxis after endoscopic cauterization of the left sphenopalatine artery.
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Nasal speculum.
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Vaseline gauze packing.
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Expandable (Merocel) packing (dry).
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Nasal vascular anatomy
Tables
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- Overview
- Presentation
- DDx
- Workup
- Treatment
- Approach Considerations
- Manual Hemostasis
- Humidification and Moisturization
- Cauterization
- Nasal Packing
- Arterial Ligation
- Embolization
- Palliative Therapy for Hereditary Hemorrhagic Telangiectasia
- Complications of Treatment
- Dietary Measures
- Activity Restriction
- Prevention of Epistaxis
- Consultations
- Long-Term Monitoring
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- Guidelines
- Medication
- Questions & Answers
- Media Gallery
- References
