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Nosebleed Causes
If you've ever wiped your nose and seen blood, you've had a nosebleed. They're common: One out of every seven people in the United States will get a one at some point. They're most common in kids between 2 and 10 years old and adults between 50 and 80 years old.
A nosebleed comes from the front of your nose (anterior) or the back of it (posterior).
It can be hard to tell if you have a posterior or anterior nosebleed. Both can make blood flow toward the back of your throat if you're lying on your back. But posterior nosebleeds can be much more serious. You're more likely to need emergency help.
Most are spontaneous, meaning they happen unexpectedly and don't have a known cause. But if you get nosebleeds a lot, there may be a reason you can pinpoint:
Also called Osler-Rendu-Weber syndrome, hereditary hemorrhagic telangiectasia is an inherited condition that causes malformations of blood capillaries that develop on the skin and mucous membranes. They may cause nose bleeds and iron deficiency anemia resulting from bleeding in the stomach or elsewhere in the gastrointestinal tract.
Nosebleeds can also be caused by bleeding disorders, but it's rare. If your nosebleed doesn't stop, or you have a lot of bleeding from your gums or when you get minor cuts, see a doctor. Bleeding disorders can be serious because platelets in your blood that help it clot are missing or aren't working.
Another rare cause of nosebleeds can be a tumor in the nose or sinuses. It may be noncancerous, also called benign, or cancerous. Only about 2,000 cases of cancerous tumors in the nose or sinuses are diagnosed in the U.S. Each year.
In some cases, nosebleeds can be caused by genes passed down in families. A rare condition called hereditary hemorrhagic telangiectasia (HHT) affects the blood vessels. The main symptom is repeated nosebleeds that seem to come out of nowhere and get worse over time.
If you have HHT, you might wake up at night with your pillow soaked in blood, and you may develop red spots on your face or hands. If one or both of your parents has this condition and you're having nosebleeds, ask your doctor about being tested for it. Treatments can help improve your symptoms.
What Causes Nosebleeds? And When Should Medical Attention Be Sought?
Nosebleeds can feel alarming, with the surge of blood dripping onto clothes or sheets and the handfuls of tissues used to stop it turning crimson.
But a bloody nose, also known as epistaxis, usually isn't serious.
"Think about if you put just a drop of blood in a toilet bowl — the whole bowl goes red," Dr. Brandon Hopkins, an ear, nose and throat specialist at the Cleveland Clinic, said last year. "It doesn't take a lot of blood to look like something extreme. We usually vastly overestimate the volume of blood that's present."
About 60% of people will experience a nosebleed during their lives. Common causes of nosebleeds include dry air due to climate or indoor heating, colds and allergies. Some nasal sprays irritate tissue inside the nose, which can cause epistaxis. People who pick their noses – and those who snort recreational drugs – also may experience bleeds.
People who take anticoagulant medication are more susceptible to nosebleeds, too. Epistaxis also can result from a sports accident, car crash or other injury.
Most nosebleeds, especially in children, are anterior nosebleeds that occur in the front part of the nose, where the tissue contains a lot of delicate blood vessels that can damage easily, according to the Children's Hospital of Philadelphia. Posterior nosebleeds are more rare and usually occur in older people or people who have had nose injuries or surgeries.
How to stop a nosebleedIf you have a nosebleed, the Cleveland Clinic recommends taking the following steps to stop it:
• Breath through the mouth.• Sit down and lean slightly forward over a bowl or cloth.• Pinch your nostrils together with your thumb and index finger for at least 10 minutes, using a timer.• Resist releasing pressure from your nose to check if the bleeding has stopped.• Repeat for another 10 minutes if the nosebleed hasn't stopped.
Nosebleeds are recurrent for about 15% of people, but only about 10% of cases are serious, according to health experts. The Mayo Clinic characterizes frequent nosebleeds as those that occur more than once a week.
"When nosebleeds are frequent, they can really get in the way of daily activities and be a significant hindrance to having a normal and healthy quality of life," Dr. David Gudis, an otolaryngology-head and neck surgery specialist at the Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, said in 2021.
Sometimes, frequent nosebleeds may be a sign of a medical condition, such as a nasal tumor or hereditary hemorrhagic telangiectasia, a genetic condition that causes abnormal blood vessel formation.
Here's when experts say people should seek medical attention:
• If they are interfering with your day-to-day life• If they occur three or four times a week, or more than six times in a month• If one lasts longer than 30 minutes, even with compression• If one involves a greater than expected amount of blood• If one interferes with breathing• If one occurs along with high blood pressure
Nosebleeds May Signal Rare Hereditary Disorder That Attacks Multiple Organs And Leads To Strokes, Two Studies By Yale Researchers Find
When epistaxis or nosebleeds occur in multiple members of one family, they are an important clue to a genetic disorder of the blood vessels called Hereditary Hemorrhagic Telangiectasia (HHT) that can lead to strokes and other symptoms, Yale researchers report in two new studies.
"The first study is the largest to show that HHT can also involve the liver, as well as the lung, brain and nose," said Robert I. White, Jr., M.D., professor of diagnostic radiology and director of the Yale Vascular Malformation Center. "The second study described HHT with lung involvement and the relationship to strokes and brain infections (abscesses). While strokes are most commonly due to heart disease or hardening of the carotid arteries, this study shows that the cause of strokes in some people may be due to a symptom of HHT."
HHT or Rendu-Osler-Weber Syndrome affects 1 in 10,000 people and is inherited by autosomal dominance, which means there is a 50 percent chance of each child inheriting the disorder from a parent affected by HHT. Within the same family, HHT patients can have a variety of symptoms, including arteriovenous malformations (AVMs), which are direct connections between arteries and veins that lack the capillaries necessary to connect these blood vessels. AVMs can occur in the nose, brain, lung, liver and stomach.
In the first study, published in a recent issue of the New England Journal of Medicine, White and a team of Yale investigators studied 19 HHT patients who had serious liver disease. These patients had nosebleeds and liver symptoms, such as shortness of breath due to increased blood flow to the liver.
"This study is one of few to look closely at the liver's involvement with HHT and its symptoms," said White. "Liver transplantation is the best chance of improving the condition, but is rarely necessary."
Patients with symptoms due to liver involvement all had nosebleeds, as well as shortness of breath or abdominal swelling, and stomach bleeding due to AVMs within the liver. After two to four years of medical therapy to treat HHT symptoms, most responded and stabilized or improved.
In the second study, published in Neurology, researchers describe the lung-brain relationship in HHT. When a person with HHT has lung involvement or pulmonary AVM (PAVM), the lung loses the filtering capacity for small blood clots and bacteria.
Results showed that patients with a single PAVM had a 25 percent risk of developing a stroke or brain abscess due to a passage of a clot or bacteria through the PAVM.
"In patients with multiple PAVMs, the risk of these events doubled," said Michael Moussouttas, M.D., a neurovascular neurologist and colleague in the Yale Vascular Malformation Center. "We now have an effective and safe non-surgical technique for managing PAVMs, which includes closing the malformation with a catheter technique that involves balloons or coils. This is essentially the opposite of coronary angioplasty, in which an artery is opened. Once the direct connection (AVM)) is closed, the patient is no longer at risk for stroke."
Each year, White and his colleagues at the Vascular Malformation Center treat about 80 patients with HHT and newly discovered PAVMs. Other centers in the United States and Canada also treat a slightly smaller number of patients. Centers based on the Yale model are also located at Odense University in Denmark; Akita University in Japan; the University of Melbourne in Australia; the Hammersmith Hospital and Royal Postgraduate Medical School in London; the St. Antonius Hospital in Utrecht, Netherlands; and two new centers in Italy at Bari and Milan.
White's colleagues on the first study included Guadalupe Garcia-Tsao, Joshua R. Korzenik, Lawrence Young, Katharine J. Henderson, Dhanpat Jain, Boyd Byrd, and Jeffrey S. Pollak. The second study included White, Moussouttas, Pierre Fayad, Mel Rosenblatt, Manabu Hashimoto and Tony Ma.
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