Nosebleed Causes: Allergies, Deviated Septum, Dryness, Trauma, and Clotting Disorders

Epistaxis (nosebleed) arises from rupture of Kiesselbach’s plexus (anterior) or Woodruff’s plexus (posterior). Common etiologies:

Local Factors

• Dry air / low humidity: Mucosal cracking.
• Trauma: Nose picking, facial injury, foreign body.
• Deviated septum: Turbulent airflow → mucosal drying/erosion.
• Inflammation: Allergic rhinitis, sinusitis, viral URI.
• Topical medications: Chronic nasal steroid/spray use (mucosal atrophy).
• Neoplasms: Juvenile nasopharyngeal angiofibroma (adolescent males), squamous cell CA, lymphoma.

Systemic Factors

• Coagulopathy: Hemophilia, von Willebrand, liver disease, DIC.
• Anticoagulants/antiplatelets: Warfarin, DOACs, aspirin, clopidogrel.
• Hereditary hemorrhagic telangiectasia (HHT): Recurrent, bilateral.
• Hypertension: Exacerbates bleeding, not primary cause.

When to Seek Care

• Bleeding >20 min despite compression.
• Recurrent (≥2/week) or heavy volume.
• On anticoagulants with INR >3.5 or trauma.
• Posterior bleed suspicion (blood down throat, bilateral).

First aid: Sit forward, pinch soft nose 10–15 min continuously. Oxymetazoline spray can aid. Cautery, packing, or embolization for refractory cases.