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Nosebleeds

Are nosebleeds common in von Willebrand disease?

Yes, nosebleeds are the most common symptom of VWD. This is especially true with children.

How can nosebleeds be stopped?

Nosebleeds may be stopped by sitting upright and firmly pinching the widest part of the nostrils together for 10 to 15 minutes. This applies direct pressure to the septum, the cartilage that divides the left and right nostrils. This is the most common site for bleeding. It may be necessary to repeat the procedure a second time. If, after two attempts, the bleeding persists, other treatments may be necessary. The nose can be packed or desmopressin can be taken.

Children should be taught to calm down as much as possible, in the event of a nosebleed.

Some people find that a cold cloth placed on the back of the neck and on the bridge of the nose is helpful in stopping bleeding.

Anti-fibrinolytic agents (Cyklokapron and Amicar) can be given for 5 to 7 days after the nosebleed to prevent re-bleeding.

Drinking hot liquids and strenuous exercise can cause the nosebleed to re-start. Therefore, it is helpful to avoid hot soup, tea or coffee and avoid lifting or straining for 24 hours after a nosebleed.

When should a doctor be consulted for a nosebleed?

If the pinching procedure does not stop the bleeding, and severe bleeding continues for more than 20 to 30 minutes, a doctor should be consulted.

Can anything be done to prevent nosebleeds?

Yes, there are several easy ways to prevent or reduce the frequency of nosebleeds.

It is important to maintain a certain level of humidity in the house, especially in the person's bedroom. This is especially important in the winter when heating makes a house much drier. A humidifier is ideal; however, an open bowl of water can also work very well.

Using petroleum jelly (Vaseline) in the nostrils every day can keep  the nostrils from drying and cracking.

In some cases, local clotting agents like Fibrin may be needed to prevent bleeding from re-occurring. The personnel at the hemophilia/bleeding disorder treatment centre will be able to help with these treatments.

Cauterizing (burning) the blood vessels in the nose is not usually recommended for people with VWD. A scab forms where the blood vessels are burned. This scab eventually falls off and bleeding can start all over again.