NASAL BLEEDING

 

 Epistaxis (nasal bleeding) is very common in indivduals with HHT. This is particularly relevant in a very dry climate

 such as we have in Alberta or interior BC. Use of direct nasal hydration with a saline-based product (i.e. secaris,

 rhinaris) at least twice daily can have a dramatic effect on epistaxis rates, as can use of a humidifier regularly.

 

 Sometimes additional medical treatments are needed, One such treatment involves tranexamic acid (TA) which is 

 available in a tablet form and intravenous form. However the risk of blood clots needs to be carefully weighed with 

 beneficial effects. A more direct use of TA as a nasal gel has been developed in Edmonton and can be used in addition

 to nasal hydration (but not in lieu of this). Many pharmacies can prepare this, however ensuring they have the right

 mixture to prepare it on site is important. The TA nasal gel is not a Health Canada approved product, variations

 in preparation can impact its effective use. Check with your HHT team and family doctor.

 

 Surgical treatments are also available, in addition to medical treatments. The most common surgical treatment involves

 endonasal laser therapy with a hemoglobin-specific laser. It is important that cautery is avoided unless in extenuating

 circumstances, as cautery can damage the normal nasal lining.

 

 Other surgical therapies involves septal dermoplasty (skin is grafted into the inner nasal lining) and a "modified 

 Young's procedure" where due to severe and ongoing bleeding the outer aspect of the nose is sewn off. These surgeries

 are not as commonly used as the endonasal laser surgery.

 

 Complementary and Alternative products including herbal supplements often have aspirin-like substances in them even

 if it is not listed. This can increase bleeding rates. Talk to your HHT team and family doctor before using / continuing any

 of these products.

 

 Certain foods (i.e. cheese) and some types of alcohol can increase nasal bleeding rates in some people with HHT. This

 is not consistently the case in everyone, so trialing being off of a food for a week or two when all else is stable in your life

 can give you a clue if this is going to be an important food for you to avoid or reduce ingestion. 

 

 Over-the-counter products for nasal bleeding - these are commonly advertised on the internet. Be careful and always

 double check with your HHT team and family doctor before trialing these.

 

 Last updated June 2019