DIAGNOSIS CHECKLIST
for Nosebleeds

Why: to determine if acute or chronic.

Why: e.g. nose picking.

Why: may indicate the cause of the nose bleeds e.g. broken nose.

Why: e.g. tooth extraction, circumcision, pregnancy - if normal response, may suggest an acquired (not inherited) bleeding problem.

Why: may suggest acute Immune thrombocytopenic purpura (ITP) especially in children.

Why: e.g. high blood pressure, hemophilia, leukemia, idiopathic thrombocytopenic purpura, Wegener's granulomatosis, liver failure, hereditary hemorrhagic telangiectasia, diabetes.

Why: medications that may reduce platelets include chloramphenicol, cytotoxic drugs, gold, heparin, phenylbutazone, sulphonamides, quinine, quinidine, thiazide diuretics; medications that cause platelet function abnormalities include aspirin, non-steroidal anti-inflammatories; medications that cause coagulation factor deficiency include warfarin.

Why: of easy bruising or bleeding; high blood pressure; hereditary hemorrhagic telangiectasia.

Why: e.g. cocaine use may cause nose bleeds.

Why: must consider nasopharyngeal cancer or acute sinusitis.

Why: e.g. bleeding gums, heavy periods, easy bruising of the skin, rectal bleeding, painful swelling of the joints - may suggest the presence of a systemic bleeding defect.

Why: may suggest myeloproliferative cancers that can cause an acquired bleeding disorder or iron deficiency secondary to blood loss.

Why: may suggest malignancy such as leukemia.

Why: dry nasal passages increase the risk of nose bleeds. Dry nasal passages may be due to Sjogren's syndrome, air conditioning, aging, menopause and cocaine use.

Why: e.g. bleeding nose, swelling around the eyes, bruising over the nose and around eyes, deformity of the nose. May be complicated by nasal septal deviation, blood clot and abscess formation within the septum or perforation of the septum. If a blood clot and abscess form within the septum, the septum can die and collapse and cause a "saddle nose deformity".

Why: e.g. facial pain and tenderness, toothache, post-nasal drip, nasal obstruction, runny nose, cough, fever, bleeding nose Symptoms of nasopharyngeal cancer? - e.g. facial pain, bloody nasal discharge, cranial nerve palsies.

Why: e.g. fever, malaise, aching muscles, weight loss, cough, shortness of breath, pus-like nasal discharge, bleeding nose, sinus facial pain and aching joints.

Why: e.g. dry eyes, dryness of the mouth, dryness of the nasal passages (and consequently increased risk of bleeding nose), skin or vagina. This syndrome may be associated with many systemic conditions such as Raynaud's phenomenon, difficulty in swallowing (as seen in systemic sclerosis), painful joints (like that seen with systemic lupus erythematosus), thyroid disease, myasthenia gravis, primary biliary cirrhosis, chronic active hepatitis, renal diabetes insipidus, renal tubular acidosis and vasculitis.

Why: e.g. sneezing; nasal obstruction and congestion; watery nasal discharge; reduced sense of smell; itchy nose, throat and eyes. May also have bleeding noses if condition is chronic.

Why: e.g. facial pain, bloody nasal discharge, cranial nerve palsies.