Abstract
Introduction: Epistaxis commonly seen in children. Although underlying causes have been defined in most cases, the etiology of this symptom can not be established some of cases. In this study, children admitted to our hospital with the complaint of epistaxis were evaluated for a possible bleeding diathesis.Material and
Method: There were 150 cases with the mean age of 7.7±3.5 years with epistaxis and investigated for bleeding diathesis. At least 60 ml of blood loss by epistaxis was considered significant. Complete blood count, renal-hepatic function tests, sedimentation rate, PT, aPTT, factor XIII and bleeding time were examined in all cases. Water’s graphy was performed in the children over 5 years of age. Bleeding time was determined by Ivy method. The cases with over 5 episodes in a year were accepted as recurrent epistaxis. We studied factor VIII, IX, vWFAg, vWF-ristocetin cofactor and thrombocyte function tests in the cases with recurrent epistaxis and elevated PT, aPTT and/or elongated bleeding time.
Results: In the present study, it was established that epistaxis occurs more frequently in boys (62%). There was no significant sexual difference in terms of bleeding diathesis and recurrent epistaxis. The children with epistaxis 1-5 times in a year, lasting less than 5 minutes and 15 ml in volume were seen more frequent, but the place of epistaxis was not statistically significant. The underlying causes of epistaxis were as follows: local factors 70.7% (infection alone or combined with other factors 48.6%), idiopathic 24%, systemic causes 5.3%.Epistaxis was recurred in 39.3% of children. Epistaxis history in the family members was statistically significant in the children with recurrent epistaxis. Bleeding diathesis was determined in 3.3% of all children and 8.4% of children with recurrent epistaxis. Bleeding diathesis was statistically significant in the children with either bilateral epistaxis or over 25 episodes in a year.
Conclusion: According to the results of this study, children admitted to hospital with epistaxis should be evaluated for infections at first. Besides, children having bilateral epistaxis should be considered bleeding diathesis and analysed for coagulation, especially bleeding time should be performed
Keywords: Epistaxis, children, bleeding diathesis
References
- McDonald TJ. Nosebleed in children. Background and techniques to stop to flow. Postgrad Med. 1987;81: 217-224.
- Jackson KR, Jackson RT. Factors associated with active, refractory epistaxis. Arch Otolaryngol Head Neck Surg. 1988;114: 862-865.
- Massick D, Tobin EJ.Epistaxis.In: Cummings CW, Flint PW, Haughey BH,Thomas JR, Harker LA, Flint PW (eds). Otolaryngology:Head & Neck Surgery. 4th ed. St Louis, Mo: Mosby; 2005:942-960.
- Tomkinson A, Bremmer-Smith A, Craven C, Roblin DG. Hospital epistaxis rate and ambient temperature. Clin Otolaryngol 1995; : 239-240.
- Viducich RA, Blanda MP, Gerson LW. Posterior epistaxis: clinical features and acute complications. Ann Emerg Med 1995; 25: 596.
- Petruson B. Epistaxis in childhood. Rhinology 1979; 17:83-90
- Beran M, Petruson B. Changes in the nasal mucosa of habitual nose-bleeders. Acta Otolaryngol 1986; 102:308-314.
- Doyle DE. Anterior epistaxis: a new nasal tampon for fast, effec- tive control. Laryngoscope. 1986;96: 279-281.
- Damrose JF, Maddalozzo J. Pediatric epistaxis. Laryngoscope ;116: 387-393. Katsanis E, Luke KH, Hsu E, Li M, Lillicrap D. Prevalence and significance of mild bleeding disorders in chidren with recurrent epistaxis.J Pediatr 1998;113:73-76.
- 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.
- Beran M, Petruson B. Occurrence of epistaxis in habitual nose- bleeders and analysis of some etiological factors. ORL J Otorhi- nolaryngol Relat Spec. 1986;48: 297-303.
- Kiley V, Stuart JJ, Johnson CA. Coagulation studies in children with isolated recurrent epistaxis. J Pediatr 1982;100:579-581.
