Nose Bleed  epistaxis cause and treatment by Ray Sahelian, M.D.
Feb 15 2014

Nose bleeding is known by the medical term epistaxis. An obvious symptom of nosebleed is blood coming down the nostril, most often it is one sided. Epistaxis is one of the commonest ENT emergencies. Although most patients can be treated within an accident and emergency setting, some are complex and may require specialist intervention. There are multiple risk factors for the development of epistaxis and it can affect any age group, but it is the elderly population who often require more intensive treatment and subsequent admission.

Cause of nose bleed or epistaxis
There are many causes of nose bleeding. A nose bleed normally begins from the nasal septum when the nasal mucosa overlying a dilated blood vessel is injured. A nose bleed may, however, signal an underlying condition such as a coagulation disorder. Most nosebleeds stop spontaneously within 5 minutes with or without pressure to the forehead, nose, or upper lip. Some require anterior nasal packing. A few arise from posterior arteries and require anterior-posterior nasal packing and a referral. These include:

Trauma to the nose can cause sudden nose bleed.
Medications
Herbs and supplements
Hereditary bleeding disorders
Cancer
Acquired bleeding disorders
Dry weather

Medications that cause nosebleeding
Aspirin - coumadin or warfarin - non steroidal antiinflammatory drugs nsaids

Herbs and supplements that may thin the blood making you a little more likely to nosebleed
Fish oils - ginkgo biloba - green tea or extract

Hereditary Bleeding Disorders causing Nosebleeding
Rendu-Osler-Weber disease or hereditary hemorrhagic telangiectasia is a multisystem autosomal dominant hereditary disorder. The disorder is manifested by multiple dysplasia of blood vessels of the skin and mucous membranes. This results in recurrent and sometimes severe bleeding, of which epistaxis is the most common.

Hemophilia (genetic disease) and the lesser known and often undiagnosed von Willebrand disease .

Childhood immune thrombocytopenic purpura (ITP) is acute and generally seasonal in nature, suggesting that infectious or environmental agents may trigger the immune response to produce platelet-reactive autoantibodies 4 to 8 weeks following an infection. In general, the patient is well apart from the diffuse bruising and petechiae indicative of a profound thrombocytopenia. Over a period of 6 months, the thrombocytopenia resolves in approximately 85% of children, while the remaining 15% with persistent platelet consumption are designated as chronic ITP patients. The peak age of acute ITP is 2 to 5 years of age, a period when children experience the greatest frequency of viral infections.

Cancer and Nosebleeding
Leukemia

Acquired bleeding disorders
Low platelet count

Am J Rhinol Allergy. 2013:  Epistaxis is a common problem that may range in severity from a minor nuisance to hemodynamically significant bleeding. Vascular anatomy allows for predictable identification of suspicious bleeding sites. Historically, packing was the workhorse of management, but, currently, more directed interventions have become available. These modalities may result in improvements in both cost-effectiveness and patient comfort.

How to stop a nose bleed - Nosebleed Remedy
The vast majority of spontaneous or traumatic nosebleeds in people who have no underlying bleeding problems stop on their own with or without ice to the forehead, pressure to the upper lip, or pinching of the nostrils against the septum. Those that continue to bleed after 3 or 4 minutes can be controlled by one of two approaches. Stopping a nose bleed can sometimes be difficult and further steps may be needed.

Do not tilt your head back since it lets blood flow into the esophagus. It risks choking, and it can cause blood to travel to the stomach, possibly leading to irritation and vomiting.

Sit down, lean forward and keep your head above your heart, which lessens the bleeding. Leaning forward also helps drain the blood from the nose and keeps it from the esophagus.

Use your thumb and index finger to squeeze the soft tissue just below the bridge of your nose for 5 to 10 minutes. A cold compress or ice pack placed across the bridge of the nose can also help.

Nose bleed treatment
If the nosebleed continues after a few minutes even when applying pressure or using ice, it may be a good idea to visit the ER, particularly if you are taking blood thinning medicines. A doctor may apply pressure to the bleeding site with anterior nasal packing. To do this, the physician topically vasoconstricts and anesthetizes the nasal mucosa. An antibiotic or a similar ointment is applied to an anterior nasal pack. The tampon is inserted with a firm grasp, using a hemostat or bayonet forceps. The tampon will swell and compress the bleeding site. Layered, 1/2-in. gauze with petrolatum is a rough but effective alternative to the tampon. A second approach is to stop the bleeding with vasoconstrictors such as topical oxymetazoline hydrochloride, cocaine, or epinephrine 1:100,000, and then to cauterize the bleeding site with silver nitrate or electric cautery.

Emails
Q. A few months I began drinking 3 cups of green tea daily for the many health benefits. I have no illness or disease. Recently, a large amount of bright red blood poured through my left nostril for about 15 minutes, this continued daily for four days. I did not experience pain, headaches or discomfort of any type. The only drug I take is one OTC Ibuprophen daily for Achilles tendonitis, I do not take aspirin. I consume vitamins daily. On the fifth day I discontinued consuming green tea and the bleeding through my nostril problem stopped. Online I found much info regarding the fact that, antiplatelet activity of green tea catechins causes blood thinning. In your opinion, could the green tea consumption be causing my blood to thin excessively, resulting in blood pouring through my left nostril?
     A. There is lots we still need to learn about the long term use of herbs. It may be the green tea, or the iboprofen, or a combination, or there may be another cause of the nosebleed and it would be a good idea to have an ENT doctor take a look, particularly if the nose bleed recurs.