Epistaxis (Nose Bleed) in Cats
Overview of Epistaxis in Cats
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 cat breed can develop epistaxis and there is no gender predilection.
Below is a brief overview of the causes of nose bleeds in cats followed by detailed information on how the underlying cause is diagnosed and treated.
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.
In cats, nose bleeds may be caused by:
Nasal foreign bodies
Dental disease, like tooth root abscess
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
Severe dental disease
Black, tarry stool (caused by swallowing blood)
A foul odor from the mouth or nose
Loss of appetite
Diagnosis of Epistaxis in Cats
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 of Epistaxis in Cats
Treatment is focused at stopping the bleeding. In addition, minimize stress for your cat. 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 of the Cat with a Nose Bleed
Often a blood clot will form and the bleeding will stop on its own. Your veterinarian still should evaluate your cat, 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.
In-depth Information on Nose Bleeds in Cats
Epistaxis or nasal bleeding is generally caused by either an acute (sudden) event, or by more insidious chronic problems.
Acute epistaxsis many times is the result of nasal fractures or lacerations caused by traumatic episodes. If there is no history of trauma, acute bleeding is often caused by the sudden erosion of a nasal blood vessel due to some primary problem within the nasal cavity, or perhaps metabolic conditions. Many times, acute epistaxis will occur, but the underling condition is a chronic or long-standing condition. Tumors, foreign bodies, and tooth root abscesses often present with acute epistaxis, yet the problem may have been present for some time.
Intermittent recurrent or chronic nosebleeds are common as blood clots form to stop the bleeding. Clots dislodging or new blood vessels becoming affected may cause future episodes of bleeding. It is also important to note whether the epistaxis is unilateral (one sided) or bilateral (both sides). Tumors, foreign bodies, and tooth root abscesses are usually unilateral. Infections and metabolic conditions are usually bilateral. If the animal has been losing weight or has been ill for some time before epistaxis is noted, it may indicate a more serious condition. It is rare for the volume of blood loss from the nose to be life threatening, rather the epistaxis is an important clinical sign that warrants further evaluation. Unless caused by trauma, epistaxis is a significant finding that often will recur if a definitive diagnosis is not reached.
Causes of Nose Bleeds in Cats
The most common causes of epistaxis in cats include:
Trauma, such as nasal fractures caused by automobile accidents, bite wounds and nasal lacerations caused by sharp objects
Nasal foreign bodies. Epistaxis will occur if a nasal foreign body punctures a blood vessel. Inflammation associated with a nasal foreign body can cause blood-tinged nasal discharge.
Dental disease. A tooth root abscess may develop if dental disease is severe or a fractured tooth becomes infected. The roots of the teeth in the maxilla (upper jaw bone) are very long. If infection develops at the base of the tooth root, it may cause swelling and break into the nasal cavity. Epistaxis occurs because the nasal blood vessels are affected. A swelling on the bridge of the nose or under the eye may be observed in a pet with a tooth root abscess.
Nasal tumors are a common cause of unilateral (one-sided) epistaxis in older cats. The most common tumors in affected cats are adenocarcinoma, chondrosarcoma, fibrosarcoma, osteosarcoma and squamous cell carcinoma.
Bacterial, fungal and parasitic infections may cause epistaxis. Only severe bacterial infections are likely to cause epistaxis. Bacterial infection may be due to trauma or a foreign body that is no longer present. Aspergillosis in cats is a fungal infection that affect the nasal cavity and may lead to epistaxis. Nasal parasites also can cause epistaxis but episodes of sneezing and rubbing at the face are more common symptoms of nasal mite infection.
Many bleeding disorders can cause epistaxis. Bleeding at other sites also may be observed. Thrombocytopenia (low platelet count) is a common cause of such bleeding problems. Platelets are blood cell fragments that are vital to the clotting process and may be decreased by several different disorders including tick-borne diseases caused by a type of bacteria called rickettsia. Rodenticides containing vitamin K antagonists are frequently the cause of generalized bleeding in cats because they interfere with activation of several clotting factors by vitamin K.
Hyperviscosity (thickening of the blood) can result from extremely high concentrations of blood proteins in pets with certain diseases. The high protein concentration leads to poor platelet function and abnormal coagulation. Occasionally, epistaxis is the first symptom of this problem. Common causes of hyperviscosity syndrome are multiple myeloma (overproduction of antibody proteins by malignant antibody-producing plasma cells), lymphoma (cancer of lymphoid tissue and lymphocytes) and erhlichiosis (a tick-borne rickettsial disease).