Nosebleeds (Epistaxis): Or something else? Differential Diagnosis

Respiratory System (J00-J99)

• Allergic rhinitis (AR) (inflammation of the nasal mucosa).
• Atrophic rhinitis – loss of mucus-forming goblet cells and ciliated epithelium with the consequences of desiccation and verborkung.
• Granulomas (usually benign, nodular tissue neoplasms) and perforations (piercing) of the nasal septum (nasal septum).
• Nasal septum deviation (nasal septum curvature).
• Polyposis nasi – formation of nasal polyps that grow destructively.
• Rhinitis sicca – inflammation of the nasal mucosa associated with severe dryness of the mucosa.
• Septal spur – spur originating from the nasal septum.

Blood, blood-forming organs – immune system (D50-D90).

• Blood coagulation disorders, unspecified (e.g., hemophilia A and B).
• Essential thrombocythemia (ET) – chronic myeloproliferative disorder (CMPE, CMPN) characterized by chronic elevation of platelets (thrombocytes).
• Werlhof’s disease – form of idiopathic thrombocytopenic purpura (ITP); idiopathic thrombocytopenic purpura refers to thrombocytopenia (lack of platelets < 150,000/μl) without an identifiable cause.
• Thrombocytopenia – deficiency of platelets (blood platelets).

Endocrine, nutritional and metabolic diseases (E00-E90).

• Diabetes mellitus (diabetes).

Cardiovascular system (I00-I99)

• Arterial hypertension (high blood pressure) – incidence (frequency of new cases) and severity of nosebleeds appear to be higher than in comparable individuals without a diagnosis of hypertension
• Atherosclerosis (arteriosclerosis, hardening of the arteries).
• Vascular malformations as in Osler-Weber-Rendu disease (synonyms: Osler disease; Osler syndrome; Osler-Weber-Rendu disease; Osler-Rendu-Weber disease; hereditary hemorrhagic telangiectasia, HHT) – autosomal-dominant inherited disorder in which telangiectasia (abnormal dilation of blood vessels) occurs. These can occur anywhere, but are found especially in the nose (leading symptom: epistaxis (nosebleed)), mouth, face, and the mucous membranes of the gastrointestinal tract. Because the telangiectasias are very vulnerable, it is easy to tear and thus bleeding.

Infectious and parasitic diseases (A00-B99).

• Infections such as dengue fever, infectious mononucleosis (Pfeiffer’s glandular fever), morbilli (measles), influenza, leptospirosis (Weil’s disease), scarlatina (scarlet fever), etc.

Liver, gallbladder and bile ducts – Pancreas (pancreas) (K70-K77; K80-K87).

• Severe liver disease (e.g., cirrhosis).

Musculoskeletal system and connective tissue (M00-M99).

• Granulomatosis with polyangiitis (GPA), formerly Wegener’s granulomatosis – necrotizing (tissue dying) vasculitis (vascular inflammation) of the small to medium-sized vessels (small-vessel vasculitides), which is associated with granuloma formation (nodule formation) in the upper respiratory tract (nose, sinuses, middle ear, oropharynx) as well as the lower respiratory tract (lungs)

Neoplasms – tumor diseases (C00-D48).

• Leukemia (blood cancer)
• Neoplasms of the nose such as juvenile nasopharyngeal fibroma, nasopharyngeal carcinoma, etc.
• Neoplasms of the paranasal sinuses.
• Pheochromocytoma – usually benign (benign) tumor (about 90% of cases), which originates mainly from the adrenal gland and can lead to hypertension crises (hypertensive crisis).

Pregnancy, childbirth and puerperium (O00-O99).

• Pregnancy

Symptoms and abnormal clinical and laboratory findings not elsewhere classified (R00-R99)

• Dry mouth (xerostomia).

Genitourinary system (kidneys, urinary tract – reproductive organs) (N00-N99).

• Kidney disease, unspecified

Injuries, poisonings, and other consequences of external causes (S00-T98)

• Foreign body
• Injuries
  • Nose
    • By “in-the-nose” (“nose-picking”) [most common].
    • Foreign body
    • Nasal bone fracture/bruise
  • Skull – traumatic brain injury (TBI).

Operations

• Condition after nose surgery

Medication

• Anticoagulants (anticoagulant drugs) such as phenprocoumon and/or antiplatelet drugs such as acetylsalicylic acid, clopidrogel (ASA).
• Nasal drops or sprays (including glucocorticoid nasal sprays).
• Medicines that irritate the mucous membranes
• Phospodiesterase-5 inhibitors

Environmental exposure – intoxications (poisonings).

• Climatic influences such as dry indoor air → dry mucous membrane.
• Dry and cold season

Further

• Chemical irritation of the mucous membrane
  • Chemicals
  • Drugs
  • Gases
  • Medicines
• Menstruation (menstrual period)
• Heavy sniffling and sneezing
• Micronutrient deficiency (vital substances): vitamins A, C and D; zinc.