What should be the diagnostic workup of a patient with recurrent severe epistaxis and normal results of the ear, nose, and throat (ENT) examination, complete blood count (CBC), and coagulation tests?
Alfonso Iorio, MD, PhD: This is a different case because the epistaxis is recurrent, there is no local cause. Particularly, if the epistaxis is bilateral and does not occur on a single side, it might be appropriate to proceed ruling out von Willebrand disease by testing von Willebrand factor. The mild form of type 1 von Willebrand disease can have a completely normal screening test result.
Testing for factor XIII deficiency—again, the standard screening test can be normal but the disease is there. Of course, before proceeding to testing, you would appropriately investigate familiality. If you do it insistently, you will very often find something.
Essentially yes, in this case I would proceed with testing.
Differential diagnosis of ITPWhat are the key steps in the differential diagnosis of immune thrombocytopenia (ITP)?
ENT surgery in a patient who bruises easilyShould we be concerned when qualifying a patient who bruises easily despite normal coagulation test results for ear, nose, and throat (ENT) surgery?
Monoclonal gammopathies: when and how to investigateA lecture by Dr Mark Crowther, from McMaster University, Canada, delivered at McMaster International Review Course in Internal Medicine in Kraków in May 2017.