400 - Thrombocytopenia Among Pediatric Patients with Epistaxis in an Emergency Department
Monday, May 1, 2023
9:30 AM – 11:30 AM ET
Poster Number: 400 Publication Number: 400.406
Andrew Shieh, University of Michigan, Ann Arbor, MI, United States; Angela C. Weyand, University of Michigan Medical School, Ann Arbor, MI, United States; James A.. Cranford, University of Michigan Medical School, Ann Arbor, MI, United States; Sarah A.. Raven, University of Michigan Medical School, Evanston, IL, United States; Lauren Bohm, University of Michigan Medical School, Ann Arbor, MI, United States; Sarah Tomlinson, University of Michigan Medical School, Ann Arbor, MI, United States
Pediatric Emergency Medicine Fellow Physician University of Michigan Ann Arbor, Michigan, United States
Background: While epistaxis in most children presenting to the emergency department (ED) is benign and self-limited, it is unclear what subset of these children may have thrombocytopenia as an etiology for their nosebleeds. Objective: Our study aim was to evaluate demographic data, epistaxis characteristics, and treatment outcomes in children with nosebleeds who were found to have previously undiagnosed thrombocytopenia at a single pediatric ED. Design/Methods: A retrospective review of children < 21 years old seeking ED evaluation from 2013 through 2021 was performed. Patients were identified using ICD-9/ICD-10 codes of epistaxis and were included if they had a complete blood cell count (CBC) drawn. Patients with prior bleeding disorders, thrombocytopenia, oncologic conditions, and those taking antiplatelet or anticoagulation medications were excluded. Thrombocytopenia was defined as platelet count less than 100,000 K/µL. Data were analyzed with descriptive statistics and outcomes were analyzed using Chi-squared, Fisher’s exact tests, and two-sample t-Tests. Results: 657 patients were seen in the ED for epistaxis, and 163 (25%) patients had a CBC drawn. In this cohort, 8 (5%) patients were found to have thrombocytopenia, including 6 patients with newly diagnosed immune thrombocytopenia, 1 with leukemia, and 1 with hemolytic uremic syndrome. The mean platelet count was 29 K/µL in the thrombocytopenia group and 279 K/µL in the non-thrombocytopenia group. Patients with thrombocytopenia were younger compared to those without thrombocytopenia (mean 7.3 vs. 11.4 years, p=0.04). Based on available documentation, thrombocytopenia was associated with epistaxis lasting one hour or longer (p< 0.01). There was no significant difference in number of nosebleeds within the past day and laterality of nosebleed between the two groups. Presence of thrombocytopenia was associated with increased use of intranasal antifibrinolytic therapy (p< 0.01), silver nitrate cauterization (p=0.04), and hospital admission (p< 0.01). Of 6 (75%) patients with thrombocytopenia admitted to the hospital, 3 received intravenous immunoglobulin, 2 received no medical intervention, and 1 started chemotherapy.
Conclusion(s): Bloodwork is not often obtained for pediatric epistaxis in the ED. Though uncommon, children of younger age and with epistaxis lasting at least one hour long may benefit from bloodwork to evaluate for thrombocytopenia.
.jpg)
.jpg)