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العنوان
Frequency and Etiology of Nosebleeds
Among Children in Pediatric Out-Patient
Clinic of Ain Shams University Hospitals /
المؤلف
Mohammad,Yasmeen Abd ElAziz.
هيئة الاعداد
باحث / Yasmeen Abd ElAziz Mohammad
مشرف / Mohsen Saleh ElAlfy
مشرف / Azaa Abdel Gawad Tantawy
مشرف / Badr Eldin Mostafa Badr Eldin
تاريخ النشر
2018
عدد الصفحات
134p.:
اللغة
الإنجليزية
الدرجة
الدكتوراه
التخصص
طب الأطفال ، الفترة المحيطة بالولادة وصحة الطفل
تاريخ الإجازة
1/1/2018
مكان الإجازة
جامعة عين شمس - كلية الطب - طب الاطفال
الفهرس
Only 14 pages are availabe for public view

from 134

from 134

Abstract

Epistaxis is a common problem in the pediatric
population in particular, with the majority of cases being self
limited and managed with simple first aid measures (Siddiq and
Grainger, 2015). Almost all types of bleeding disorders may
present with epistaxis including coagulation factor deficiencies,
von Willbrand disease, and inherited platelet function disorders
(Israels et al., 2010 and Nurden et al., 2012).
In the light of the above mentioned facts we designed a cross
sectional study that was conducted in the out-patient clinic of
the Pediatric Hospital of Ain Shams University to measure the
frequency of epistaxis as the presenting symptoms among
children who attended pediatric outpatient clinic, and to
estimate the severity of epistaxis using severity score as an
assessment tool, and to determine possible underlying etiology
of epistaxis and estimate frequency of secondary epistaxis due
to bleeding disorder, and by using a pediatric bleeding
questionnaire as a screening tool for detecting bleeding
tendency in children with epistaxis; trying to reach the
underlying etiology of epistaxis to diagnose underlying
bleeding tendency that may spare those patients the risk of a
life threatening bleeding one day.
The study was conducted throughout a period of one year
between the 22nd of December 2015and 22nd of December
2016, all recruited subjects were older than two and younger than 18 years with a mean of 7.89±3.8 years and included 53
females and 47 males. 57 patients were presented by other
bleeding manifestations; the highest associated bleeding
manifestation was cutaneous bleeding. The least association
was bleeding after teeth extraction.
Seventeen patients out of 100 patients had comorbidities.
Five of them had local comorbidities; three of
them had allergic rhinitis and one had paranasal sinusitis. The
other twelve had systemic co-morbidities mainly in the form of
diabetes mellitus and gastrointestinal disease.
Basic screening by complete hemogram as well as PT,
INR and PTT were performed for all recruited patients.
Patients with normal bleeding profile in the form of
normal hemogram as well as normal PT, INR and PTT yet a
bleeding score exceeding or equal 2 which signifies an
underlying bleeding had von Willebrand antigen assay as well
as von Willbrand cofactor activity together with platelet
function tests with ADP and ristocitein
The total number of patients visiting the out- patient
clinic was 30043 we recruited 100 patients of them who
presented by epistaxis, showing a frequency of one in three
hundred cases presented by epistaxis.
100 patients presented with epistaxis were recruited in
our study. 43 presented with epistaxis only; 37 patients had normal ENT assessment and normal initial hematological
assessment (CBC, PT, and PTT), they were diagnosed as
idiopathic epistaxis, 6 patients had local ENT causes.
Our results revealed no significant difference while
comparing the underlying cause of epistaxis in relation to age,
sex of recruited patients, consanguinity of their parents or
recurrence of attacks. While there was a statistically significant
difference for a positive family history for epistaxis, in the
favor of the systemic cause.
As our out-patients clinic is a tertiary center, we address
the effect of referral on the prediction of cause of epistaxis.
There was high statistically significant difference between
patients as regard referral from a primary care physician in the
favor of having a systemic underlying cause of epistaxis.
There was a statistically significant difference as regard
the seasonal variation in patients with systemic or local
underlying cause of epistaxis in favor of the local cause of
epistaxis.
There were a statistically significant higher number of
patients presented with epistaxis in the months of June, July,
August and September and lower number in February and
March. As for the site of bleeding most of the patients with
epistaxis (90%) were presented by anterior bleeding, ten had
undetermined site of bleeding and none had posterior bleeding.
Out of 100 patients presented with epistaxis; the majority
(96%) had only nasal compression while only 4 had anterior
pack and 2 performed cautery.
57 patients were presented with bleeding manifestations
beside the epistaxis and were expected to have bleeding
disordres; out of them 10 patients had undiagnosed bleeding
tendency. The number of cases definitely diagnosed as bleeding
disorder were 47 patients; 16 had immune mediated defect (14
patients had ITP and 2 patients had autoimmune diseases
(antiphospholipid antibody syndrome and systemic lupus)), 25
inherited defect (12 patients had platelet function defect, 10
patients had VWD, one patient had factor 7 deficiency, one
patient had hemophilia A and another had hemophilia B) and 6
had other diseases ( 4 patients had bone marrow disease, One
patient had DIC, one patient had post streptococcal
glomerulonephritis and hypertension). 43 patients are now
regularly following up at pediatric hematology clinic.
In our study a bleeding score of 2 or more was of high
statistical significance in detecting an underlying systemic cause
of bleeding, it gave sensitivity of 85.9% and specificity of 95.35.
While epistaxis severity score had statistically significant value in
detecting an underlying systemic cause of epistaxis and it gave
sensitivity of 66.67% and specificity of 58.14%.