Laboratory Evaluation for Frequent and Profuse Epistaxis

Essential Laboratory Tests

The American College of Cardiology recommends obtaining a complete blood count (CBC) to evaluate for anemia and assess the severity of blood loss in patients with frequent and profuse epistaxis 1, 2
A hemoglobin drop ≥2 g/dL is associated with significantly increased mortality risk and indicates major bleeding requiring aggressive management in patients with frequent and profuse epistaxis 1, 2
The American College of Cardiology suggests that patients with cardiovascular disease are at higher risk of mortality from significant hemoglobin drops 1
The American College of Cardiology recommends requesting PT/INR and aPTT in all patients with clinically relevant bleeding, especially those on anticoagulation 1, 2

The American College of Cardiology recommends monitoring vital signs closely, as tachycardia may be the first sign of hemodynamic instability from blood loss in patients with frequent and profuse epistaxis 1, 2
Systolic blood pressure <90 mmHg, a decrease >40 mmHg, or orthostatic changes indicate hemodynamic instability in patients with frequent and profuse epistaxis 1, 2

The American College of Cardiology recommends aggressive management for patients with high-risk features, including hemoglobin drop ≥2 g/dL or requirement for ≥2 units of packed RBCs transfusion 1, 2
Significantly elevated INR in anticoagulated patients requires aggressive management in patients with frequent and profuse epistaxis 1
Thrombocytopenia or abnormal coagulation studies suggesting bleeding disorder requires aggressive management in patients with frequent and profuse epistaxis 1
Evidence of hemodynamic instability with laboratory confirmation of significant blood loss requires aggressive management in patients with frequent and profuse epistaxis 1, 2