From the Guidelines
The initial workup for a patient presenting with bleeding from the ear and gums should prioritize assessing vital signs, determining hemodynamic stability, and obtaining a detailed history, followed by laboratory tests including a complete blood count, coagulation studies, and consideration of specialized tests like von Willebrand factor assays if a bleeding disorder is suspected. When evaluating a patient with bleeding from the ear and gums, it is crucial to consider the potential for underlying coagulopathy or thrombocytopenia, as suggested by studies such as 1 and 1, which emphasize the importance of immediate actions in dealing with massive hemorrhage, including control of obvious bleeding points and administration of high FO2I. Key aspects of the initial workup include:
- Assessing vital signs and determining hemodynamic stability, as active bleeding may require immediate intervention
- Obtaining a detailed history focusing on medication use, recent trauma, bleeding disorders, liver disease, and alcohol use
- Laboratory tests should include:
- Complete blood count to assess for thrombocytopenia
- Coagulation studies (PT/INR, PTT) to evaluate for coagulopathy
- Liver function tests and renal function tests
- Consideration of specialized tests like bleeding time, platelet function studies, and von Willebrand factor assays if a bleeding disorder is suspected, as outlined in 1, which provides an algorithm for initial laboratory evaluation for von Willebrand disease or other bleeding disorders. Imaging studies such as CT scan may be necessary if trauma is suspected, particularly for ear bleeding, and management depends on the underlying cause, which may include local measures to control bleeding, vitamin K for warfarin-associated bleeding, platelet transfusions for severe thrombocytopenia, fresh frozen plasma for coagulation factor deficiencies, or specific factor concentrates for identified deficiencies, as discussed in 1 and 1. Given the potential for significant morbidity and mortality associated with uncontrolled bleeding, a comprehensive and timely approach to diagnosis and management is essential, prioritizing the patient's hemodynamic stability and addressing the underlying cause of the bleeding.
From the Research
Initial Workup for Bleeding from Ear and Gums
The initial workup for a patient presenting with bleeding from the ear and gums involves a thorough assessment to determine the underlying cause of the bleeding.
- The approach to the patient with bleeding begins with a thorough bleeding, medical, and family history to determine the nature of bleeding and severity of bleeding symptoms 2.
- A complete blood cell count, platelet count, and evaluation of a peripheral blood sample, a prothrombin time, and an activated partial thromboplastin time are routine screening tests that can be ordered 3.
- The patient's history, physical findings, and evaluation of a well-prepared peripheral blood smear will be helpful in determining the cause of the patient's thrombocytopenia 3.
Laboratory Investigations
Laboratory investigations for bleeding disorders often include:
- Prothrombin time (PT)/international normalized ratio (INR)
- Activated partial thromboplastin time (APTT)
- Fibrinogen level
- Thrombin time (TT) 4
- Von Willebrand disease (VWD) screens and light transmission platelet aggregometry (LTA) may also be included in the panel to increase sensitivity to bleeding disorders 4.
Diagnosis and Therapy
Diagnosis and therapy of bleeding in ENT (ear, nose, and throat) require a thorough assessment of the patient's condition and may involve operative or interventional therapy if necessary 5.
- Aggressive resuscitation is the principal step for achieving haemodynamic stabilization of the patient, which will further allow appropriate interventions to be made for the definite control of bleeding 6.