CLINICAL CONFERENCE

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Abstract
Dr. Schulman: The patient I would like to discuss this afternoon demonstrates a problem which is quite common in pediatric practice, namely that of severe and recurrent epistaxis. The patient is a 9-year-old boy who had manifested repeated episodes of epistaxis since the age of 2 years. The nosebleeds occurred most commonly during the night and more frequently during the winter than the summer months. They usually were not associated with trauma although, on occasion, they did follow sneezing. They seemed to occur more frequently when the child had a concurrent upper respiratory infection. In most instances the nosebleeds stopped spontaneously after a few minutes, but on at least three occasions they were so profuse as to require hospital attention and nasal packing. At the age of 3 years, the child was seen by a physician who informed the mother that something was wrong with the child's platelets and that transfusions would be required each time the child had a nosebleed. During the subsequent 2 years the child was admitted to the hospital for transfusion on several occasions. When the child was 4 years of age the mother sought further advice from a hematologist and the patient was completely evaluated from the standpoint of hemorrhagic disease. No abnormality was found. However, the first physician insisted that a platelet defect was present and informed the mother that transfusions were still required with each nosebleed in order to prevent exsanguinating hemorrhage. Oven the succeeding 5-year period the child received numerous transfusions of whole blood, and in recent years with fresh frozen plasma. The nosebleeds had not increased in number or frequency during this period and the child was otherwise clinically well. Two weeks ago the child was brought to the Children's Memorial Hospital for further study. The past history disclosed no evidence of a bleeding tendency apart from the nosebleeds. Specifically there had been no easy bruising, no bleeding following circumcision, or eruption of the teeth, and no development of hematomata after the usual immunization injections. Complete family history was likewise negative for any evidence of an abnormal tendency to bleed.

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