Conditions: Nosebleed (Epistaxis)

Thin blood

The phrase “thin blood” is meant to describe any abnormality affecting the blood’s ability to clot. Poor clotting ability may be the result from use of a drug that hinders clotting, low numbers of functional platelets, or a lack of available clotting proteins (among others). In general, our blood needs to strike a balance between clotting and bleeding. We want blood to clot only when it is sealing a leak, but to remain liquid when it is flowing in vessels. Medications that shift blood’s natural balance in favor of bleeding can be very helpful in preventing blood clots, pulmonary embolism, and heart attack, but may also predispose to hemorrhage. Decision making in use of medications to “thin” the blood involves balancing risk of clotting against risk of bleeding.

Nasal trauma

Trauma to the nose can break open blood vessels. Trauma includes self-induced finger contact within the nose and surgery.

High blood pressure

High blood pressure may help cause a nosebleed by rupturing the blood vessel or a partially healed blood vessel. Additionally, high blood pressure promotes ongoing bleeding, which washes away the beginning of a clot before it has organized into a strong seal. After a recent nosebleed, a healing blood vessel may not be as strong as a normal blood vessel, so high blood pressure may rupture the weak vessel wall, leading to more bleeding. Blood pressure is a major driver of ongoing nose bleeding. In my experience, systolic blood pressure (the higher number on a blood pressure reading) above 130 makes control of a nosebleed difficult, and above 150 makes control of bleeding unlikely.

Dry air

Dry air promotes crusting on the surface of the nose. Dry air is predominant in an air-conditioned environment and in the winter. When surface crusts are dislodged, they may tear the surface including blood vessels. This is true of mucus as well as scabs on the surface of the nose.

Infection

Nose or sinus infection cause increased blood flow and the potential for damage to tissues.

Nasal septal deviation or nasal perforation

Any irregularity in shape of the nasal septum may lead to some areas having greater exposure to dry air or contact (such as by a finger).

Nasal or sinus tumor

Less commonly, the cause of recurrent nosebleeds is a tumor within the nose or sinuses. Tumor tissue in general may be weak and bleed easily, but tumors may also erode into normal blood vessels to cause bleeding.