Clinical and laboratory features of 178 children with recurrent epistaxis

• Published in: Journal of pediatric hematology/oncology Vol. 24; no. 1; p. 47
• Main Authors: Sandoval, Claudio, Dong, Stella, Visintainer, Paul, Ozkaynak, M Fevzi, Jayabose, Somasundaram
• Format: Journal Article
• Language: English
• Published: United States 01.01.2002
• Subjects: Adolescent; Blood Coagulation Disorders - diagnosis; Child; Child, Preschool; Epistaxis - blood; Epistaxis - etiology; Epistaxis - physiopathology; Female; Hemoglobins - analysis; Humans; Infant; Male; Partial Thromboplastin Time; Platelet Count; Recurrence; Retrospective Studies
• ISSN: 1077-4114
• DOI: 10.1097/00043426-200201000-00013

To determine the clinical and laboratory features of 178 children referred for the evaluation of recurrent epistaxis to an outpatient hematology clinic in a university medical center. Medical records of 3681 outpatient pediatric hematology referrals were retrospectively review, and 178 children with recurrent epistaxis from 1985 to 1999 were identified. Historic (other bleeding symptoms: gingival bleeding, easy bruising, menorrhagia, and gross blood in the urine or stool: duration and severity of the epistaxis episodes; and family history of bleeding) and laboratory (complete blood count and coagulation tests) data were analyzed. There were 103 boys and 75 girls with a median age of 84 months (range 15-219 months). Sixty-seven percent (n = 119) did not have a coagulopathy diagnosed and 33% (n = 59) did. The diagnoses included von Willebrand disease in 33, platelet aggregation disorders in 10, thrombocytopenia in seven, mild factor VIII deficiency in three, Bernard-Soulier syndrome in two, factor VII deficiency in one, factor IX deficiency in one, and factor XI deficiency in one, and coagulation inhibitor in one. Of the historic data, only a family history of bleeding was predictive of diagnosing a coagulopathy (P = 0.023). The duration and severity of the epistaxis and the presence of other bleeding symptoms had no predictive value. Children with a coagulopathy diagnosed had a longer median partial thromboplastin time (PTT) (33.1 vs. 30.5 seconds; P = 0.012). One-third of children presenting with recurrent epistaxis have a diagnosable coagulopathy. A positive family history and a prolonged PPT are useful predictive data.