Patient's question:
Every few days, I have to bleed, about 10 to 15 times a year, and I have never been treated.Doctor's answer:
Nosebleed (epistaxis), also known as epistaxis, is one of the common clinical symptoms, mostly caused by nasal cavity lesions, but can also be caused by systemic diseases. Occasionally, bleeding from nearby nasal cavity lesions may flow out through the nasal cavity. Nosebleeds are usually unilateral but can also be bilateral; they may occur intermittently and repeatedly or continuously. The amount of bleeding varies, with mild cases having only blood in the nasal discharge and severe cases causing hypovolemic shock. Repeated bleeding can lead to anemia. Most bleeding can stop on its own.Causes
The causes can be categorized into local factors or systemic factors.
Local Factors
1. Trauma to the nose, such as impact or excessive nose picking.
2. Deviated septum, ridges, or spurs, with thin local mucosa that is prone to bleeding due to air irritation.
3. Acute rhinitis or atrophic rhinitis, which increase the risk of bleeding.
4. In a few cases, bleeding is caused by tumors in the nasal cavity, sinuses, or nasopharynx, such as angiofibromas or malignant tumors.
Systemic Factors
1. High arterial pressure, such as hypertension or arteriosclerosis.
2. Elevated venous pressure, such as mitral valve stenosis or pulmonary edema.
3. Acute febrile infectious diseases, such as upper respiratory infections or influenza.
4. Blood disorders, such as leukemia, hemophilia, or various purpuras.
5. Liver, spleen diseases, and rheumatic diseases.
6. Poisoning from phosphorus, arsenic, benzene, etc., which can impair hematopoietic system function and cause bleeding.
7. Compensatory menstruation.
Most nosebleeds occur in the anterior-inferior part of the nasal septum, where dilated blood vessels form vascular plexuses, known as the "dangerous area" of the nasal septum. In a few cases, bleeding may occur in the posterior part of the nasal cavity or other areas. Most nosebleeds are unilateral, with bleeding amounts ranging from very small to arterial hemorrhage, even leading to shock.
Guidelines
(I) General Principles
1. The patient should be comforted.
2. Severe nosebleeds may lead to insufficient blood supply to the cerebral cortex, causing restlessness. Tranquilizers, such as barbiturates, can be administered. However, for the elderly, diazepam or promethazine is preferred. In cases of heart failure or pulmonary heart disease, morphine should be avoided to prevent respiratory depression.
3. If shock symptoms appear, the airway should be monitored. If respiratory obstruction is present, it should be relieved first, while effective shock treatment is administered.
(II) Local Hemostatic Methods
Treatment should vary based on the cause and condition.
1. Pressure method.
2. Constrictive method.
3. Caustic method.
4. Cryotherapy.
5. Pterygopalatine canal injection (greater palatine foramen injection).
6. Packing method.
(III) Systemic Treatment
1. Semi-recumbent rest, with attention to nutrition and a high-calorie, easily digestible diet. For the elderly or those with significant bleeding, monitor for anemia, shock, or cardiac damage and treat promptly. Severe bleeding may require blood transfusions and intravenous fluids.
2. Identify the bleeding cause and provide targeted treatment.
3. Administer sufficient vitamin C, K, and P, along with appropriate sedatives.
4. Intravenous injection of 50% glucose, 5% calcium chloride, or thromboplastin (3–4 ml, intramuscularly, twice daily) to promote coagulation. Appropriate use of hemostatic agents, such as tranexamic acid, epsilon-aminocaproic acid, or Yunnan Baiyao.
5. For prolonged nasal packing, antibiotics should be added to prevent infection.
(IV) Surgical Treatment
Surgical treatment can be considered as needed. For minor bleeding in the anterior part of the nasal septum, cold compresses or nasal packing with or 1% ephedrine-soaked cotton balls can be used. Various hemostatic sponges, thromboplastin, or thrombin may also be applied. For more significant bleeding, a doctor should examine the patient to locate the bleeding site. Common hemostatic methods include caustic treatment, cryotherapy, or packing with petroleum jelly gauze (anterior or posterior nasal packing). Severe but minimal bleeding may require vessel ligation or embolization. In addition to local treatment, systemic hemostatic drugs should be used, with blood transfusions and intravenous fluids if necessary. The underlying cause should also be identified and treated accordingly.