Manifestation of a Congenital Disorder
Many thanks for the detailed and successful article on the topic of epistaxis. Please allow me to express a point of criticism, however: although coagulopathies were mentioned among the causes of epistaxis (the syndrome is no longer called “Willebrand-Jürgens syndrome”, but is known as “von Willebrand syndrome”), hemostaseological diagnosis and treatment are neither included in the algorithm (Figure 2) nor are they mentioned in the list of CME questions (1). Repeated nosebleeds, especially if common in entire families (the family medical history was also omitted) may be the manifestation of a congenital or acquired disorder and, not least in view of future surgical interventions, should be investigated hemostaseologically. With a prevalence of 1%, the von Willebrand syndrome is not rare and may require treatment with desmopressin, tranexamic acid, or von Willebrand factor concentrate. Acquired thrombocytopenia—for example, in the context of immunothrombocytopenia—is not rare as well and is associated with substantial risks and consequences that vastly exceed local management. A relevant addition to the algorithm and the CME questions is advisable.
Dr. med. Wolfgang Mondorf
Praxis und Labor zur Diagnostik
und Therapie von Blutgerinnungsstörungen
Frankfurt am Main
Conflict of interest statement
Dr Mondorf has received conference delegate fees, travel and hotel expenses, and a lecture honorarium from Pfizer.
|1.||Beck R, Sorge M, Schneider A, Dietz A: Current approaches to epistaxis treatment in primary and secondary care. Dtsch Arztebl Int 2018; 115: 12–22 VOLLTEXT|