Epistaxis : Diverse Causes – Hematologist has a significant role in optimal care

Background: Epistaxis is among the most common otorhinolaryngological emergencies, affecting up to 60% of the population. While most cases are benign and managed with local measures, unusual hematological causes may underlie recurrent or severe presentations. Objective: To present a case series highlighting diverse hematological etiologies of epistaxis encountered during the initial practice period of a budding hematologist in a remote region of Karnataka, India. Methods: Six consecutive patients presenting with epistaxis were evaluated comprehensively. Detailed hematological workup was performed, and management was tailored to the underlying diagnosis. Results: The series included: Drug-induced thrombocytopenia managed successfully with TPO agonists. Paroxysmal nocturnal hemoglobinuria diagnosed during pancytopenia evaluation and referred for anti-complement therapy trials. Fanconi anemia confirmed by cytogenetics and mutation analysis, managed with transfusion support and antifibrinolytics, with transplant planning underway. Immune thrombocytopenic purpura treated with steroids and hematinics. Eisenmenger syndrome with erythrocytosis managed by phlebotomy. Erythrocytosis with suspected acquired von Willebrand disease controlled with local measures, hydration, and lifestyle modification. Conclusion: This case series underscores the importance of hematologist involvement in epistaxis evaluation, especially in uncovering rare and systemic causes beyond routine ENT practice. Awareness of conditions such as PNH, Fanconi anemia, acquired vWD, and drug-induced thrombocytopenia is crucial for timely diagnosis and appropriate management. Presentation: This work was presented at the Association for Haemophilia and Allied Disorders – Asia Pacific (AHAD AP) 2024, Bengaluru, India.