الفهرس 
coverOnly 14 pages are availabe for public view
 |  | from | 122 |  |  |
| | | from | 122 | | |
Abstract
Epistaxis is a common childhood symptom that may prompt a referral to
a pediatric hematologist or otolaryngologist . Epistaxis also is the most
common bleeding symptom and may herald the presenceof bleeding
disorders.Objectives: to evaluate children and adolescents presenting
with epistaxis and determine variables that can predict an underlying
bleeding disorder and if they varied among both agegroups.
Methods:Sixty three cases of pediatric patients with recurrent epistaxis
who presented to the ENT Pediatric outpatient clinic as well as
Hematology outpatient clinic, Cairo University Pediatric Hospital.The
study also included those presenting with acute severe epistaxis to the
emergency department(ED) whether ENT or Pediatric as well as those
required admission to inpatient wards.Patients included in the study from
June 2010 to December 2010 were subjected to detailed history taking
with emphasis on :history of bruising and/or other bleeding symptoms,
family history of a bleeding disorder( epistaxis,menorrhagia or bleeding
on hemostatic challenge as surgery or dental extraction )and treatment
received. Results:There were 33boys and 30 girls with a mean age of
6.08 years ( range 2-18 years).Fourty -eight percent (n=30) had bleeding
disorder and 52%(n=33) did not. The most common bleeding disorder
was platelet abnormalities; idiopathic thrombocytopenic purpura (ITP) in
8 patients and 7 had platelet dysfunction, 4Glanzmann’s thrombasthenia
and 3Bernard Soulier syndrome. One patient had aplastic anemia ,one
hemophilia A and one vWD type 1. However, 12 caseswere considered
as unclassified bleeding disorder.Positive consanguinity, duration of
epistaxis,epistaxis score and other bleeding symptoms were predictive in
those with bleeding disorder(p< 0.001) .The age ,sex ,family history and
recurrence had no predictive value. Patients withbleeding disorder had lower median hemoglobin level(Hb)( 10.10 vs. 12.00 gm/dl; p< 0.001),
lower median platelets count (plt)( 199.50 vs. 364.00×10
9
/L; p< 0.001)
and longer median activated partial thromboplastin time (aPTT)( 30.50
vs. 27.00; p< 0.001). In children with age of onset≤10 years only
duration of epistaxis and aPTT found to be statistically significant
(p <0.05) Conclusion:Fourty -eight percent had bleeding disorder.A
positive consanguinity , duration of epistaxis,epistaxis score , other
bleeding symptoms, low hemoglobin level, low platelets count and
prolonged activated partial thromboplastin time are useful predictive
data. In children with age of onset ≤10 years the duration of epistaxis, in
association with APTT were statistically significant(p < 0.005)and so
indicating that these variables can be predictors of an underlying
diagnosis.