Health Science | Causes and Countermeasures of Nosebleeds in Patients with Blood Diseases

Nosebleed is one of the common clinical symptoms. It can be caused by local lesions of the nose or systemic diseases. It is especially common in patients with blood diseases. When patients with blood diseases have nosebleeds at home, they are often at a loss. A large amount of nosebleeds can lead to changes in the patient's condition or even death. The causes and countermeasures of nosebleeds have become the focus of nursing care for patients with blood diseases.

Common causes of nosebleeds

1. Intranasal injury:

Frequent rubbing of the nose, picking the nose, and violent sneezing may damage the nasal mucosa, causing local capillaries or mucosa rupture and nosebleeds. Long-term use of hands to pick dry scabs in the nasal cavity can easily lead to erosion and bleeding of the nasal mucosa. Cases of frequent nose picking causing nosebleeds are relatively common in clinical practice. 2. Dry nasal mucosa:

Dry air in the environment or room causes dryness of the nasal mucosa and reduced nasal secretions. Excessive dryness of the nasal mucosa can easily lead to vascular brittleness, which can damage the nasal mucosa after sneezing or a runny nose, causing nosebleeds.

3. Increased blood pressure:

If the patient has high blood pressure for a long time, it may cause the fragility of nasal capillaries to increase, thus leading to nose bleeding;

4. Related to the primary disease

Due to the abnormalities in the quality and quantity of platelets in patients with blood diseases, disseminated intravascular coagulation is easily induced in severe infections.

5. The incidence of epistaxis after chemotherapy is high

After chemotherapy, the patient is in a bone marrow suppression period, and the platelet count is further reduced compared to before chemotherapy. Generally, when the platelet count is <10X109/L, active bleeding increases significantly.

These methods of stopping bleeding are wrong

1. Tilt your head back to stop nosebleeds

When you have a nosebleed, you often subconsciously look up, which makes it seem like the bleeding has stopped. In fact, this not only has no effect on stopping bleeding, but also causes blood to be swallowed into the esophagus and gastrointestinal tract, irritating the gastrointestinal mucosa, causing discomfort and nausea, and even black stools, affecting medical examinations.

If the nosebleed is large, it is easy to inhale it into the trachea and lungs, blocking the airway, which may cause respiratory obstruction or stagnation and endanger life. Therefore, you should not lie down when you have a nosebleed. You should keep your body and head slightly tilted forward to let the nosebleed flow out smoothly.

2. Raise your arm to stop nosebleeds

Some folk remedies, based on the theory that "one side of the brain controls the opposite side of the body", believe that raising the opposite arm will cause the nerves around the nose on that side to become excited, thereby constricting the blood vessels and reducing bleeding; some folk remedies believe that raising the same-side arm will slow down the blood flow in the same-side blood vessels in the body and reduce bleeding. These have no scientific basis, and raising the arm has no effect on stopping nosebleeds.

The correct way to stop bleeding should be like this

1. Pressing hemostasis method:

When nasal bleeding is found, quickly sit up or semi-recumbent. If the amount of bleeding is small, you can use finger pressure to stop the bleeding. You can pinch the tip of the nose with your fingers or gently press the nose wing on the bleeding side with your thumb for 10 to 15 minutes, and ask the patient to open his mouth to breathe and spit out the secretions in his mouth.

2. Cold compress method:

Use ice cubes to cool the root of the nose. Lowering body temperature can reduce blood flow to the nose. You can also use a cold water bag or wet towel to cool the forehead and back of the neck at the same time, or hold an ice cube in your mouth to cause blood vessels to contract and reduce bleeding.

3. Go to the hospital in the following situations

Most occasional nosebleeds are not a serious matter, and there is no need to panic too much if you have an occasional nosebleed, but if the following situations occur, it is still recommended to see a hospital for treatment.

1. Frequent nosebleeds. Frequent nosebleeds should be considered as pathological factors. Even if it is not a serious disease, repeated bleeding can lead to anemia and insufficient blood supply to the brain.

2. If nose bleeding still occurs after pressing for 10 minutes, you should press the nose and go to the hospital immediately.

Go to the hospital for treatment promptly.

How to prevent nose bleeding

1. The key is not to pick your nose.

2. Patients with hypertension should pay attention to their blood pressure.

3. When the air is dry, the nasal mucosa is prone to rupture and bleeding. You can use compound menthol nasal drops to drip into the nose, 1-2 drops at a time, three times a day; rinse the nasal cavity with physiological sea salt water, 1-2 times a day, which can effectively moisturize the nose.

4. Dietary guidance

Most patients with blood diseases and nasal bleeding have anemia, so they should choose liquid or semi-liquid food that is high in protein, vitamins, and iron. Eating more fresh vegetables and fruits is beneficial to the healing of the mucosa.

5. In daily life, it is recommended that you pay attention to rest, avoid staying up late, overwork, and drink plenty of water to replenish water. Pay attention to rest and avoid staying up late and other negative emotions.

Nasal packing care

1. Pain care

After nasal packing, there will be pain in the nose and forehead. Assist the patient to rest in a semi-recumbent position and raise the head to reduce congestion and edema in the head, thereby relieving pain. At the same time, intermittent cold compresses should be applied to the nose and forehead according to the pain situation. If the pain is unbearable, analgesics can be given according to the doctor's advice.

2. Oral care

During nasal packing, mouth breathing can easily cause dry mouth and bad breath. Instruct patients to drink more water and rinse their mouths frequently to keep their mouths clean and moist. Apply paraffin oil or lipstick to lips to prevent chapped lips when necessary. Take good care of the oral cavity and observe changes in the oral mucosa at any time.

3. Prevent the filling from falling out

During the period of nasal packing, the packing should be prevented from falling out. Instruct the patient not to cough or blow the nose forcefully. If the patient wants to sneeze, he or she can restrain the sneezing by opening the mouth and taking a deep breath, pressing the tip of the tongue against the upper palate, etc. Cod liver oil can be dripped into the patient's nasal cavity regularly for lubrication. If the packing partly falls out, it can be cut off, but it is strictly forbidden to stuff the gauze strip back into the nasal cavity to prevent infection. Patients with posterior nasal packing should pay attention to whether the packing falls out backwards. Once it is found to fall out, it should be tightened and fixed immediately to avoid suffocation.

4. Extraction of fillings

The nasal packing should be removed after 48 hours of anterior nasal packing and 72 hours of posterior nasal packing. After the packing is removed, the nasal cavity should be carefully observed for active bleeding. If there is a small amount of nasal bleeding, ice packs can be applied to the nose and forehead intermittently. Assist the patient to use cod liver oil nasal drops to keep the nasal cavity moist, and instruct the child not to blow the nose hard and try to avoid sneezing to prevent nasal bleeding again.

5. Observation of the condition

Patients should measure their own body temperature, pulse, respiration, blood pressure and other changes at home; observe whether the patient has symptoms of shock from the patient's complexion, consciousness, urine volume, etc.; monitor blood oxygen saturation and observe whether there are symptoms of hypoxia such as drowsiness and slow reaction; accurately record the amount of nasal bleeding, pay special attention to whether there is blood overflow from the posterior wall of the nasopharynx. If there is overflow, ask the patient to spit it out to observe the amount of bleeding and prevent blood from being swallowed and causing nausea and vomiting. If any discomfort occurs, please go to the nearest hospital for treatment in time.

Nosebleed is one of the common complications of patients with blood diseases. In addition to systemic medication, local hemostasis is very important. Relax your nervous emotions and mentality, use the correct hemostasis methods and precautions, and take effective nursing measures to prevent bleeding, reduce the adverse consequences caused by nosebleeds, and improve the quality of life of patients with blood diseases. (Wang Shang, Beijing Lu Daopei Hematology Hospital)