Differential Diagnosis for 35-year-old Female at 34 Weeks Pregnancy with Nasal Congestion, Nasal Bleeding, and Mildly Elevated Blood Pressure
- Single Most Likely Diagnosis
- Pregnancy-induced Hypertension with Epistaxis: This condition is a common cause of nasal bleeding in pregnant women, especially in the third trimester. The mild elevation in blood pressure supports this diagnosis, as pregnancy-induced hypertension can lead to vascular changes that increase the risk of epistaxis.
- Other Likely Diagnoses
- Rhinitis of Pregnancy: This condition is characterized by nasal congestion and is common during pregnancy due to hormonal changes. While it doesn't directly cause nasal bleeding, the increased blood flow and congestion could potentially contribute to epistaxis.
- Iron Deficiency Anemia: Common in pregnancy, iron deficiency anemia can lead to increased blood pressure and potentially to epistaxis due to decreased blood viscosity and increased cardiac output.
- Do Not Miss Diagnoses
- Preeclampsia: Although the blood pressure elevation is described as mild, preeclampsia is a condition that can rapidly progress and is a significant risk to both mother and fetus. Nasal bleeding can be an associated symptom due to the endothelial dysfunction and coagulopathy that can occur in preeclampsia.
- Thrombocytopenia: Either due to gestational thrombocytopenia or as part of a syndrome like HELLP (Hemolysis, Elevated Liver enzymes, and Low Platelet count), thrombocytopenia can increase the risk of bleeding, including epistaxis.
- Rare Diagnoses
- Wegener's Granulomatosis (Granulomatosis with Polyangiitis): A rare autoimmune disorder that can cause nasal congestion, bleeding, and hypertension. It's less likely but could be considered if other symptoms like renal involvement or lung symptoms are present.
- Hereditary Hemorrhagic Telangiectasia (Osler-Weber-Rendu Syndrome): A genetic disorder characterized by the formation of abnormal blood vessels, which can lead to recurrent epistaxis. It's rare and would require a family history or other systemic manifestations to consider.