Abstract
Objective: Children with recurrent epistaxis despite medical therapy may be at higher risk of having a bleeding disorder. The objective of this study was to identify the prevalence of previously undiagnosed bleeding disorders in children with severe epistaxis who failed medical therapy requiring intraoperative nasal cautery.
Method: Retrospective chart review from October 15, 2006 to December 31, 2010. Inclusion criteria: children (<19 years) with epistaxis referred to otolaryngology, no known bleeding disorder, and failed medical therapy requiring nasal cautery. Data collected: duration and severity of epistaxis, bleeding history, family history of bleeding. Screening CBC, PT and PTT were performed on all of patients.
Results: Of 248 subjects referred for epistaxis, 47 met study inclusion criteria (mean age 8.6 ± 3.8 years; male:female ratio 29:18). Coagulation studies revealed 12.8% (6/47) prolonged PT, 8.5% (4 /47) prolonged PTT, 10.6% (5/47) prolonged PT and PTT. Three with borderline levels proceeded to surgery. Twelve were referred to hematology secondary to abnormal coagulation studies. Of these, five patients (5/12, 42%) were diagnosed with a bleeding disorder (3-type 1 von Willebrand’s disease (VWD), 1-platelet aggregation disorder, and 1-factor VII deficiency). Overall, 6.4% (3/47) had VWD in this cohort, which is higher than the reported prevalence of 1%.
Conclusion: Knowledge of whether a child has a coagulopathy prior to surgery can limit complications. In this highly selected group of patients with persistent epistaxis, 10.6% (5/47) had a bleeding disorder. It is important to consider hemostatic testing in high risk patients.
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