What Causes Nosebleeds With Large Blood Clots?

Active bleeding from the nose or epistaxis is a fairly common occurrence among people of all age groups and both genders. An estimate of about 60% of the population experiences nosebleeds or epistaxis at least once or more in their lifetime; the degree of epistaxis however varies.

Anatomically, the most common site for nosebleeds to occur is the anterior portion (front) of the nasal septum called the Little’s area. This area is enriched with a plexus of blood vessels and is also highly prone to digital trauma (injury due to finger and fingernails) and drying. Nosebleed from Little’s area is usually self-limiting and can be easily controlled without any medical assistance.

About 5-10% of cases of epistaxis occur due to bleeding from the posterior nasal cavity. These nosebleeds are venous in origin and since their site of bleeding is difficult to localize, they are also fairly more difficult to treat.

This article will give you an insight into the causes and treatment for nosebleeds with large blood clots along with home remedies to prevent and treat it.

Causes Of Nosebleeds With Large Blood Clots

Nosebleeds with large blood clots can occur due to several causes ranging from simple trauma to major systemic illnesses. The intensity of nosebleed too can range from mild epistaxis with few drops of blood to severe bleeding lasting for an hour or more requiring medical help to control.

The following are some of the causes of nosebleeds with large blood clots;

1. Traumatic

• Digital trauma (from fingers or fingernails)
• Facial trauma
• Drying up of nasal mucosa
• A foreign body lodged inside the nose
• Perforation of the nasal septum
• Inhalation of substances that may damage nasal mucosa
• Barotrauma – Bleeding due to increased air or water pressure
• Allergy to environmental irritants

2. Infections

• Upper respiratory tract infections
• Sinusitis
• Rhinitis
• Tuberculosis
• Mononucleosis
• Rheumatic fever
• Syphilis

3. Tumors or lesions

• Neoplasms of the sinuses
• Naso-pharyngeal neoplasms
• Nasal polyps
• Nasal hemangioma
• Metastasis from other sites

4. Disorders Of Blood And Coagulation

• Leukemia – Cancer of blood or bone marrow resulting in the production of excess white blood cells
• Thrombocytopenia – Low platelet counts
• Haemophilia
• Von Willebrand's disease
• Aplastic anemia
• Platelet inhibition
• Anticoagulant medications
• Vitamin K deficiency
• Hepatic diseases
• Uremia

[Also Read: Health benefits of vitamin K]

5. Anatomical Issues

• Deviated nasal septum
• Telangiectasias - Small dilated blood vessels near the surface of the skin
• Very thin mucosal membrane

Diagnosis Of Nose Bleeds With Large Blood Clots

Before beginning any kind of treatment, an initial assessment regarding the onset of recent complaints is important. Appropriate laboratory investigations may be advised by your doctor to identify the underlying cause.

The following information is valuable while evaluating a case of nosebleeds with large blood clots;

• History of recurrent episodes of epistaxis
• Frequency of nosebleeds
• History of local trauma
• History of drug or alcohol abuse
• History of taking anticoagulants
• Family history of bleeding disorders or cardiovascular illnesses

The physician will use a good light source along with appropriate instruments for examination of the nasal cavity to visualize the site of bleeding.

Treatment For Nosebleeds With Large Blood Clots

Treatment for nosebleeds with large blood clots depends largely upon the causative factor as well as the severity of bleeding. Accordingly, a treatment approach can be one or a combination of the following;

1. In the case of discrete nasal bleeding and when the site of bleeding can be easily identified, electro-cautery is the treatment of choice. Vaso-constrictive and hemostatic medications along with nasal packing may also be used.
2. Hypertension must be considered as a potential cause for worsening or persistent nosebleeds and must be treated. Often, patients become anxious and show relative hypertension at the sight of blood.
3. Local application of vasoconstrictor drugs allows better visualization of the nasal cavity and also controls bleeding.
4. In case of excessive bleeding, persistent bleeding, or when the site of bleed cannot be localized, nasal packing is opted for. Nasal packing can be anterior, posterior, or both.
5. Nasal tampons are available in various sizes and can be used in cases of uncomplicated nasal bleeding. Some limitations to using nasal tampons are;
• They can be used for anterior nasal packing and rarely for posterior nasal packing.
• Patient discomfort is a major drawback of nasal packing
• Soaked nasal tampons may obstruct the airways due to clotted blood.
• Pressure necrosis of the nasal mucosa and nasal cartilage is a significant complication of nasal packing.
• Another complication includes a high risk of infection. Therefore, antibiotics must be administered prior to nasal packing to prevent infections.
6. To stop bleeding from the posterior nasal cavity, a nasal catheter, or Epistat can be used. This instrument has a balloon at its end which is inflated.
7. Patients who undergo nasal packing require hospitalization and close monitoring to ensure adequate oxygenation and effectiveness of the nasal packing.
8. In case of massive hemorrhage from the nose, the patient must be hospitalized and needs intravenous administration of fresh frozen plasma, platelets, and vitamin K is required along with close monitoring of the vital status of the patient.

When To See A Doctor For Nosebleeds With Large Blood Clots?

Nosebleeds with large blood clots are a fairly serious problem as it may be an indication of some major underlying disorder. It is therefore essential to visit the doctor as soon as you notice bleeding from the nose, irrespective of the cause.

Tips To Prevent or Manage Nosebleeds With Large Blood Clots

1. Carry nose clamps, especially if you suffer from recurrent epistaxis
2. Identify triggering factors for nosebleeds and as far as possible avoid these triggers
3. Carry wipes, small towels, or plastic bags with you
4. Keep fingernails short. Also, avoid excessive picking of the nose as it can damage the nasal mucosa causing bleeding
5. Avoid harsh blowing of the nose
6. Apply ice on the nose as soon as you notice bleeding
7. Avoid eating or drinking hot foods and drinks if you have had a recent episode of epistaxis
8. Avoid bending over for long durations as this increases pressure on the nose
9. If you are hypertensive, ensure regular timings of your anti-hypertensive medications

In conclusion, the management of epistaxis requires consideration of several factors. Even a case of mild nosebleed may become severe enough and arouse a life-threatening situation for the patient if the underlying cause is serious. It is therefore important to visit the doctor as soon as the episode begins and avoid managing it at home completely.