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Epistaxis (Nose Bleed) in Cats

By: Dr. Douglas Brum

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Epistaxis refers to bleeding from the nose. It is usually from damaged vessels in the nasal mucosa but can also be due to an increased fragility of capillaries or bleeding tendencies. Any breed can develop epistaxis and there is no gender predilection.

The bleeding may be acute (sudden) or chronic (long standing). How ill the animal becomes often is determined by the underlying cause of the nasal bleeding. It is important to determine if the bleeding is unilateral (one-sided) or bilateral (both nostrils) because some causes of epistaxis are associated with unilateral bleeding whereas others are associated with bilateral bleeding.

Epistaxis may be caused by:

  • Trauma
  • Nasal foreign bodies
  • Dental disease, like tooth root abscess
  • Nasal tumors
  • Infections (bacterial, fungal, parasitic)
  • Certain blood disorders, such as clotting abnormalities, excessively viscous blood, tick-borne diseases that can cause low platelet counts

    What to Watch For

  • Sneezing, accompanied by a large spray of blood
  • Nasal swelling
  • Severe dental disease
  • Fractured teeth
  • Black, tarry stool (caused by swallowing blood)
  • A foul odor from the mouth or nose
  • Noisy breathing
  • Loss of appetite

    Diagnosis

  • Your veterinarian will take a complete history and perform a thorough physical examination, which may lead to a prompt diagnosis with minimal diagnostic testing, especially if trauma is the cause. Careful oral and nasal examinations under anesthesia may be needed to completely inspect the mouth, back of the throat, and front part of the nasal cavity (just within the nostrils)

  • A complete blood count (CBC or hemogram) to identify anemia, inflammation or infection, or a low platelet count that may be contributing to the epistaxis

  • Serum biochemistry tests to evaluate the overall health of your pet and to evaluate vital organ function

  • A urinalysis to evaluate kidney function, check for infection, and to identify proteinuria that can be associated with some causes of epistaxis

  • Tests of blood clotting including a platelet count, von Willebrand's factor (to check for von Willebrand's disease, a relatively common inherited clotting abnormality in dogs), and other tests of blood clotting (e.g. prothrombin time, partial thromboplastin time, activated clotting time)

  • Serologic tests for infectious diseases, especially fungal diseases (histoplasmosis, blastomycosis) and tick-borne rickettsial diseases, like ehrlichiosis and Rocky Mountain Spotted Fever

  • Nasal and dental radiographs may be recommended based on these findings

    Additional tests may be recommended if a diagnosis cannot be established from the previously described evaluations. These include:

  • Fine detail X-rays of the nasal cavity

  • Computerized tomography (CT) (a specialized type of X-ray procedure that allows individual "slices" of the head to be examined). This test has somewhat limited availability but is not extremely expensive.

  • Magnetic resonance imaging (MRI) (a specialized test the provides highly detailed views of "slices" of the head). This test has limited availability and can be very expensive.

  • Rhinoscopy (evaluation of the nasal cavity with a fiberoptic endoscope) and nasal biopsy. You may be referred to a specialist in veterinary internal medicine for this procedure, which must be performed under general anesthesia

  • Exploratory surgery of the nasal cavity for definitive diagnosis and possible treatment

    Treatment

    Treatment is focused at stopping the bleeding. In addition, minimize stress for your pet. Sedation may be necessary to decrease excitement and agitation. The following may also help:

  • Cold compresses and direct pressure to help decrease bleeding

  • Adrenaline (i.e. epinephrine) can be applied in the nose to control bleeding

  • In severe cases, general anesthesia may be required to allow packing of the nasal cavity with gauze so as to provide direct pressure to control bleeding

    Home Care

    Often a blood clot will form and the bleeding will stop on its own. Your veterinarian still should evaluate your pet, but an emergency visit probably is not required. Meanwhile, do the following:

  • Limit stress and decrease excitability (sedation may be required for this purpose).

  • Apply cold compresses and direct pressure to help decrease the bleeding.

  • If the bleeding does not stop, gets worse or if bleeding is observed at other sites, consider it an emergency and call your veterinarian immediately.

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