Investigations
1st investigations to order
Investigations to consider
FBC and ‘group and save
Test
Have a low threshold for requesting a full blood count and 'group and save' (e.g., if the patient is haemodynamically unstable, has had significant blood loss, is frail and elderly, has a clotting disorder or bleeding tendency, or is on anticoagulation).[6][16]
‘Group and save’ is essential preparation should blood transfusion become necessary.
Result
haemoglobin and haematocrit usually normal; may be low if bleeding has been prolonged, recurrent, or profuse
clotting studies (INR, prothrombin time, activated partial thromboplastin time, platelet function tests)
Test
Request clotting studies if the patient:
Is on anticoagulant medication[6]
Has a history of suspected or confirmed coagulopathy[6]
Has chronic liver disease or chronic kidney disease, because of the association with bleeding tendency.[10]
Check for over-anticoagulation.[16]
Result
clotting studies abnormal if coagulopathy; INR usually normal, may be raised if coagulopathic or patient over-anticoagulated
urea and electrolytes and serum creatinine
Test
Have a low threshold for requesting urea and electrolytes and creatinine (e.g., if the patient is haemodynamically unstable, has had significant blood loss, is frail and elderly, has a clotting disorder or bleeding tendency, or is on anticoagulation).[6][16]
Result
usually normal; may be abnormal if liver or kidney disease or volume depletion
liver function tests (LFTs)
Test
In practice, only request LFTs if the patient has chronic liver disease, you are concerned about the patient's general medical condition, or if there are unexplained clotting abnormalities.
Gamma-glutamyl transpeptidase (GGT) can be useful if high alcohol intake is suspected.
Result
usually normal; abnormal if underlying liver disease; GGT may be raised
CT scan of paranasal sinuses
Test
Rarely indicated in a non-traumatic presentation of epistaxis.
Discuss with ENT if you are concerned about a neoplasm, such as juvenile nasopharyngeal angiofibroma, which typically occurs in an adolescent boy with unprovoked, unilateral and profuse epistaxis and associated unilateral nasal obstruction.[10]
Consider ordering an MRI depending on initial findings.
Result
may be normal; or may demonstrate:
fracture
expansile, erosive process suggesting neoplasm
sinus opacification if sinusitis or neoplasm
intranasal soft-tissue density if polyposis present
ECG
Test
Consider requesting an ECG depending on comorbidities.
Result
may be normal or abnormal
Use of this content is subject to our disclaimer