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