Epistaxis
Epistaxis cases represent a significant proportion of ENT workload both
at first presentation and re-presentation with blood transfusion use
found to be more common than documented in the
literature.16 Our data shows emergency epistaxis
accounted for 42.2% of patients and 43.9% of RBC units transfused.
Risk factors such as hypertension and being on antithrombotic medication
have been shown to increase median haemostasis time in epistaxis
patients and thus, likely contribute to the requirement for a blood
transfusion however, no direct causal link has been
established.16 Murer et al. conducted a retrospective
cohort study of epistaxis patients and identified the following risk
factors for epistaxis-related transfusions: trauma, haematological
disorders such as Hereditary Haemorrhagic Telangiectasia (HHT) and
posterior origin of bleeding.17 In our centre, we have
seen a decrease in epistaxis-related transfusions between 2015 and 2019,
which could be due to better recognition and earlier intervention in
severe epistaxis cases, improved early warning systems and reduced
caseload year on year. Additionally, earlier endovascular treatment in
the course of a patient’s management, which is available in our centre,
has previously been suggested to decrease the need for blood
transfusions.18