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Epistaxis (Nose Bleed) in Cats

By: Dr. Douglas Brum

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Diagnosis In-depth

Many times a diagnosis can be made on the basis of a good history and physical exam. If the diagnosis cannot be established, then certain basic lab tests are indicated:

  • Complete blood test (CBC) checks for anemia, evaluating how significant the blood loss might be. The white blood cell analysis may show evidence of infection or certain types of cancer. The platelet count is also estimated.

  • The biochemical profile rarely identifies a primary problem causing the epistaxis, although the total proteins are measured (hyperviscosity syndrome). It is still a valuable test to rule out any secondary diseases, concurrent problems, and to minimize anesthetic risk.
            
  • Infectious disease titers for fungal diseases such as aspergillosis may be indicated, as well as an Erhlichia titer. Erhlichiosis can cause a decreased platelet count and an increased plasma protein level.
  • Clotting tests are indicated to rule out any clotting abnormalities. Clotting abnormalities may be inherited, caused by toxins, metabolic conditions or inherited.

  • An oronasal exam under anesthesia is useful to evaluate for dental disease, obvious nasal masses or foreign bodies. This procedure is often combined with other procedures that require general anesthesia, such as nasal x-rays and biopsies.

  • Nasal and dental radiographs require anesthesia and may show a tooth root abscess or an area of bony destruction caused by a tumor. In general nasal X-rays, although widely available, are not as good a diagnostic tool as CT or MRI scans.

  • Nasal biopsies may be obtained using X-rays as a guide. These are generally considered blind biopsies, since the mass is not visualized during the biopsy procedure. Typically a long thin probe with a cutting tip is inserted through the nares to an approximated area. Biopsies may be taken at the point where a lesion is suspected.

    Your veterinarian may recommend that more specialized testing is needed to diagnose the primary problem. These tests may only be available at larger referral practices and include:

  • Computed tomography (CT) and magnetic resonance imaging (MRI) are useful in imaging nasal masses and the extent of bony involvement. Knowing the exact location of the mass is useful in order to biopsy the mass to get an accurate diagnostic sample.

  • Rhinoscopy is the procedure of using a very small flexible fiber optic scope to visualize the structures in the nose. The tube is placed through the nares and advanced. Tumors, foreign bodies and the specific bleeding area may be identified. Foreign bodies may be recovered and biopsies obtained.

  • Surgery or a nasal exploratory is generally the last step taken if a diagnosis has not been made. An incision along the bridge of the nose allows for visualization of the nasal cavity. Masses and foreign bodies may be removed, or biopsies obtained.

    Treatment In-depth

    Your veterinarian may recommend one or more of the diagnostic tests described above. In the meantime, treatment of the symptoms might be needed, especially if the problem is severe. The following non-specific (symptomatic) treatments might be applicable to some, but not all pets with epistaxis. These treatments may reduce severity of symptoms or provide relief for your pet. However, nonspecific therapy is not a substitute for definite treatment of the underlying disease responsible for your pet's condition.

  • Stress should always be minimized. Stress, excitement and panting can cause animals to dislodge clots and further bleeding to occur. Stress also increases blood pressure, which could further increase bleeding. If the animal is in good health, drugs that sedate as well as decrease blood pressure like acepromazine are very useful.

  • Cold compresses and direct pressure on the nose will promote the constriction of the blood vessels and help in decreasing the blood flow and promote clot formation.

  • General anesthesia is occasionally required to stop the bleeding, especially if the patient is uncooperative. Epinephrine causes a powerful constriction of the blood vessels and may be instilled in the nose using a syringe. If needed, gauze-like material (e.g. umbilical tape) can be packed into the nose producing more direct pressure on a bleeding area and thus promote faster clotting.

  • In traumatic injuries usually the bleeding stops on its own or with supportive care. Nasal tumors may be surgically removed, treated with chemotherapy or have radiation therapy. Fungal infections often respond to intranasal antifungal or oral antifungal agents. Tooth root abscesses improve with tooth removal and antibiotics. Many bleeding disorders are very treatable once the primary problem is identified. Specific therapy requires the specific cause to be identified.

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