Repeated epistaxis post Rhinoscopy

RE: Repeated epistaxis post Rhinoscopy

Anthony Dennison — Mon, 10 Feb 2020 13:49:54 GMT

Thanks everyone for the advice. Coags and Haematology were all normal. I've been off for 2 weeks so just checked - dog hasn't been in since so I think it has self resolved! Have used tranexamic acid in the past, so may use this if it recurs

RE: Repeated epistaxis post Rhinoscopy

Andrew Kent — Sat, 25 Jan 2020 13:41:17 GMT

Hi Anthony - some of these nasal cases can be really tricky.

I doubt this is related to your biopsies after this length of time so more likely the underlying disease. In the absence of massive change on CT I think a coagulopathy is certainly possible although the previous purulent discharge suggests there is a degree of nasal disease.

Many of these end up needing repeat CT 6-8 weeks later to look for progression that increases suspicion of aspergillosis or other. Also consider unusual causes such as nasal arteritis or vascular malformation as they are not always that obvious on imaging.

Can you see where the bleeding is coming from?

Andy

RE: Repeated epistaxis post Rhinoscopy

Dinu Catilina — Fri, 24 Jan 2020 20:11:42 GMT

I doubt the trauma could have been so severe to cause a deviated septum with little acute changes at the time. I would expect at least severe local swelling.

I also believe the epistaxis not to be a consequence of your rhinoscopy.

The last case I had which also had rhinitis and bled extensively after rhinosopy responded well to Tranexamic acid.

RE: Repeated epistaxis post Rhinoscopy

Beats — Fri, 24 Jan 2020 20:09:29 GMT

Some random, and largely uneducated, thoughts:

checking clotting good idea. I've had occasional hemophiliac GSD - can do DNA test (http://www.laboklin.co.uk/laboklin/showGeneticTest.jsp?testID=8222D) if interested and think a possibility. [Anecdote alert!] Last 2 year old GSD I had with hemorrhaging through nose had normal PT/APTT (on IdexxCoagDx anyway), negative for lungworm, platelets looked OK but was horribly azotemic and had drank gallons since puppy - I assumed uremic coagulopathy.

On a purely practical note I've had some cases with repeated and severe nasal hemorrhage for a variety of reasons (and in the absence of a diagnosis) do very well with just tranexamic acid (pennies) PO and the owners no longer had to squirt adrenaline / xylometazoline down their nostrils when they started bleeding or rush in as an emergency.

If there is a clear correlation with steroid giving and bleeding then they may be a useful part of management. perhaps a steroid inhaler might be an option longer term if this correlation continued?