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Q. For the past six years, my son is suffering from nosebleeds. Please help.

Hi doctor,

My son is 12 years old. His weight is 40 kg. The problem is bleeding from the nose for the past six years, no habit of nose picking, no history of trauma, bleeding starts at any time of the day, and also without any physical work during sleeping or inactivity. I have consulted with many ENT and Pediatrician in the past. The bleeding stops on using injection Trenaxa but again starts when its effect wears off. Bleeding is occurring in all seasons, but more in summer. Bleeding occurs even after all precautions. Intermittently it starts and stops for weeks. Runny nose problem is present since early childhood, especially during eating. This problem is present in father and grandfather also. In early childhood, there is a history of cold and cough frequently. I have attached all the reports.

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Hello,

Welcome to icliniq.com.

Following is my opinion on your asked question.

In the attached reports (attachments removed to protect the patient's identity), aPTT (activated partial thromboplastin time) value is high. So hemophilia and other coagulation factor deficiencies have to be ruled out.

For that, you can discuss with your pediatrician about investigating with SGPT (serum glutamic pyruvic transaminase), serum albumin estimation, and all coagulation factor estimation.

Suppose coagulation profile comes normal, then idiopathic thrombocytopenia purpura (ITP) could be possible. For that, bone marrow aspiration can be done for further work-up.

According to the cause, management can be planned.

If there is any coagulation factor deficiency, then factor replacement or FFP (fresh frozen plasma) can be prescribed.

You can revert with coagulation factor assay estimation reports.

Meanwhile, during bleeding from the nose, nose pinching with thumb and index finger can be done to stop bleeding temporarily.

I hope I have answered your question.

Let me know if I can assist you further.

Best regards.


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