Persistant Nose Bleeds with Coughing up Blood Clots.

[kamnikpking]

Hi my name is Stephanie Morgan. I have a cousin with a horrible history with Sickle Cell Disease she is 34 years old, she was diagnosed two years old. She has gone from everything from strokes, Heart surgeries, you name it! My cousin Ebony has been having these nose bleeds; she has been having them off and on for over six months she will bleed for HOURS, literally. It’s getting worse, now it’s almost a steady flow for hours her count went to a 3 which is deadly for a Sickle Cell Patient. The doctors have not really figured it out they thought possibly it was the Plavix she was taking but they stopped it and she is still having the bleeds, again worse. They have done test but they are not really coming up with much again it’s been going on for months and her nose is just being packed when she is in the hospital it stops and that’s, that. I'm not the smartest person in the world but I just don't understand and getting extremely scared for my cousin and her family. Please if anyone knows anything or has suggestions I can bring up to my cousins, doctors I would truly appreciate it???  

[baby1966]

My son had the same thing and I've never seen some one cough or had so much blood come out their nose or mouth and I took him to the emergency room he stayed in the hospital for three days. They ran a camera down his throat to look inside of him and they found a bleeding ulcer on his intestine so they clamped it together and put him on medication for his stomach..

[vedadhar]

Epistaxis or persistent nose bleeding is indicative of systemic causes in absence of previous history of injury or surgery to nose.It can happen in coagulative disorders like Sickle cell anemia or von Williebrand's disease or Hemophelia,where coagulation pathway is abnormal and bleeding persists despite of measures taken.Situations like panic or nervousness/ anxiety,sneezing may also trigger nose bleed.

Little's area or Kiesselbach plexus(anterior bleeds),Woodruff plexus (posterior bleeds) being the most dependent and sensitive anastamosis (junction of blood vessels) under tip of nose.In case of uncontrolled hypertension,infections,genetic disorders,arteriosclerosis,in association with Clotting disorders like Sickle Cell Anemia,Epistaxis is often hard to manage.

Preliminary management may include Tamponade (pressure by gauze) or Pinching of tip of Nose (exiting the nerves,stoppage of bleeding to allow clotting) carried on for about 20 mins,also tilting the head forward to prevent airway obstruction.Application of Cold pack may help since ice promotes vasoconstriction (constriction of blood vessels).These methods are effective when practiced simultaneously one after another keeping the airway intact and bleeding under control.

But when these measures do not control bleeding, OTC drugs like Topical (applied over) Oxymetazoline or Phenylephrine  (nasal decongestants) may be used for this purpose.Application of antibiotic ointmnet may be preferred for recurrent nose bleeds to prevent infections or sinusitis.

If the problem still persists,medical measures like Electro cautery or chemical cautery with Silver nitrate should be done by Attending Doctor in ER.

Epistaxis should be controlled by first aid and should seek medical attention if she is bleeding for hours.How could they or you let this happen?No wonder her Hbg levels are too low.In case of acute sickle cell disease(diagnosed),levels drop up to 6-8g/dL but if it is falling beyond this,main reason would be persistent bleeding.So prevention of bleeding and treating the root cause is very important.

Consider genetic counseling,make treatment plans for sickle cell disease as effective medical management is available to deal such problem.If the tests does not show anything then reevaluation in a higher center is recommended to eliminate all possible differentials of genetic or systemic clotting disorders or abnormality in anatomy of nose,etc.Talk to your Doctor and come up with certain questions.All The Best,God Bless!