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Old 06-19-2011
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Arrow Nose Bleed! Any modification will be appreciated!

HPI: 28 yo F co nose bleed of 3 month duration . She has it at least twice a week, which last for about 5 minute. It getting worse, and she has it mostly at the morning. Nothing seems to worse the condition. She bleeds form the left side, estimate the blood amount by 2 teaspoon. She denies nasal trauma, nasal pain. She state that for the last 3 month she become bruise easily, and feels tired.
She denies URTI, post nasal drips.
OB/GYN: LMP 2weeka go, regular q 28 days ,last for 4 days, change 3 pads a day
ROS: Negative except as above
PMH: None PSH: None
Med : ASA All: NKDA
FH: No hx of bleeding d/o
SH: denies cocaine use, no smoke, EtOH,Sexually active with her husband only.

PHYSICAL EXAMINATION-
Looks well, not in acute distress
HEENT: ATNC, no clots were seen in the nose, no obvious deformities , no tenderness over the nose
Chest: CTA bl
Heart: RRR S1 S2 normal. No rubs , murmur or gallop
Abd: Sot lax, NO HSM
Ext: Petechiae over the Lt arm and Rt thigh

DIFFERENTIAL DIAGNOSIS -
Nasal trauma- Foreign body
Anemia
ITP
vW diseasse
Intra nasal tumor
DIAGNOSTIC WORKUP -

CBC
PT PTT INR BT
vw factor level
MRI- head
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  #2  
Old 06-19-2011
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According to your history, ITP and VWD should be the first few diagnosis, then for investigations, u can add platelet count, ultrasound/CTscan to rule out hypersplenism and i think the last one would be Bone Marrow biopsy to see for megakaryocytes.
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