From the Research
Laboratory workup for pediatric nosebleeds is generally not necessary for isolated, uncomplicated epistaxis that resolves with basic measures. However, laboratory testing should be considered for recurrent, severe, or difficult-to-control nosebleeds, especially when associated with concerning symptoms. The recommended workup includes a complete blood count (CBC) to assess for anemia or thrombocytopenia, coagulation studies including prothrombin time (PT), partial thromboplastin time (PTT), and international normalized ratio (INR) to evaluate for bleeding disorders, and in some cases, specialized tests like von Willebrand factor assay, factor VIII and IX levels if a specific coagulation disorder is suspected, as suggested by 1.
Key Considerations
- Most pediatric nosebleeds are anterior bleeds caused by local factors like digital trauma (nose picking), dry air, or minor trauma, and don't require extensive laboratory evaluation unless they're severe, recurrent, or accompanied by other bleeding symptoms like easy bruising, gingival bleeding, or petechiae.
- A baseline hematology evaluation with hemoglobin and hematocrit levels starting at age 12 months, or younger if clinically indicated, can be useful in identifying underlying conditions, as noted in 2.
- Coagulation studies, including PT, PTT, and INR, can help identify bleeding disorders, but their interpretation requires practice and consideration of individual patient factors, as discussed in 3 and 4.
Testing Recommendations
- CBC to assess for anemia or thrombocytopenia
- Coagulation studies, including PT, PTT, and INR, to evaluate for bleeding disorders
- Specialized tests, such as von Willebrand factor assay, factor VIII and IX levels, if a specific coagulation disorder is suspected
- Blood typing may be necessary for severe bleeding requiring transfusion
Clinical Judgment
Additional testing should be guided by clinical suspicion of specific disorders, such as hereditary hemorrhagic telangiectasia, and the presence of concerning symptoms. The decision to perform laboratory tests should be based on the individual patient's presentation and medical history, as emphasized in 1.