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A 35-year-old male presented with 5 months of right-sided epistaxis.

He had a remote history of nasal trauma, and a septoplasty 5 months prior. Since that time, he had had significant right-sided epistaxis requiring multiple episodes of nasal packing. He has no personal or family history of bleeding disorders, has normal vital signs; hematocrit (HCT) 29.1; and platelets, international normalized ratio (INR), and partial thromboplastin time (PTT) normal.

Upon arrival at our emergency department, the patient’s bleeding was eventually controlled with packing bilaterally and systemic administration of tranexamic acid.


Please use the discussion feature below to ask the authors your questions and provide further feedback on others’ questions. All questions and replies are moderated.


  1. Pshdar Mohammed Waisi

    Haematological investigations and Endoscopic examination and CT scan for nose and para nasal sinuses to exclude any pathology.

  2. Dr Vivek Jainkeri

    Diagnostic Nasal Endoscopy should be done. Recurrent spontaneous epistaxis could be due to post op granulations or a tumor.

  3. Dr Mohanned A Disher

    Can you perform rhioscopy to the pat upon arrival? Or the bleeding prohibits you?
    For how long the packing stayed?
    Did you do rhinoscopy after removal of the packs?

  4. Lakshmi Vasudevan

    His Blood pressure
    Was rhinoscopy done ?


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