Classification of nasal bleeding

Currently, the most common classification IA. Kurilina and A.N. Vlasyuk, which is based on the pathophysiological principle. Given that this classification was proposed in 1979, a number of its provisions have become obsolete, therefore some adjustments were made to it, taking into account the achievement of modern hematology. However, at the present time, no matter what classification in terms of the etiological causes of nasal bleeding is not considered, they all have their own merits and demerits.

• Nasal bleeding caused by changes (disorders) of the vascular system of the nasal cavity.
  • Injuries.
  • Dystrophic changes in the mucosa of the nasal cavity.
  • Curvature of the septum of the nose.
  • Anomalies in the development of the vascular system of the nasal cavity.
  • Neoplasms in the nasal cavity and paranasal sinuses (bleeding polyp septum, angiomas, angiofibromas).
• Nasal bleeding as a manifestation of disorders of the blood coagulation system.
  • Decrease in activity of plasma factors of the coagulating system of blood:
    • violation of the 1st phase of coagulation (haemophilia A, B, C);
    • violation of the 2nd phase of coagulation (dysprotrombia);
    • violation of the 3rd phase of coagulation (afibrinogenemia or hypofibrinemia, dysfibrinogenemia or the production of abnormal fibrinogen);
  • Decrease in activity of platelet factors of the coagulating system of blood - thrombocytopathy;
  • An increase in the activity of the anti-rejuvenating system of blood:
    • increased concentration of circulating direct anticoagulant (heparin);
    • increased concentration of anticoagulants of indirect action;
  • Hyperfibrinolytic conditions.
• Nasal bleeding caused by combined effects of changes (disorders) of the vascular system of the nasal cavity and coagulation properties of the blood;
  • Dystrophic lesions of endothelium or endothelial dysfunction in atherosclerosis, arterial hypertension, etc.
  • Hemorrhagic diathesis:
    • immune (in typhus, sepsis, scarlet fever, measles, malaria, brucellosis, influenza, parainfluenza, adenovirus diseases, etc.) and autoimmune vasculitis (both primary diseases and manifestations of systemic autoimmune pathological processes);
    • neurovegetative and endocrine vasopathies (juvenile; senile, associated with menstrual irregularities, with the intake of glucocorticoids);
    • hypovitaminosis C and P;
    • immune and autoimmune thrombocytopathy;
    • von Willebrand disease;
    • hemorrhagic angiomatosis (Rundu Osler's disease),
  • Chronic liver diseases:
    • hepatitis;
    • cirrhosis;
  • Chronic inflammatory diseases of the nose and paranasal sinuses:
    • purulent rhinosinusitis;
    • allergic rhinosinusopathy.
  • Diseases of the blood (acute and chronic hemoblastosis - leukemia, polycythemia, aplastic and megaloblastic anemia, lymphoproliferative diseases, acute radiation sickness).

Nasal bleeding is also shared by the localization of their source.

• Nasal bleeding from the vessels of the nasal cavity.
  • From the front parts of the nasal cavity.
  • From the back of the nasal cavity:
    • the source of bleeding is located above the middle nasal conch;
    • the source of bleeding is located below the middle nasal concha.
• Nasal bleeding from vessels located outside the nasal cavity.
  • Bleeding from the paranasal sinuses, nasopharynx.
  • Bleeding from the intracranial vessels:
    • from the intra-carotid aneurysm of the internal carotid artery;
    • from the vessels of the dura mater in the fracture of the trellis plate.

The division of nasal bleeding from the localization of their sources to the anterior and posterior ones is explained by the difference in tactical approaches with these forms. With anterior nasal bleeding, a bleeding vessel, as a rule, is in the Kisselbach zone. Diagnosis of posterior nasal bleeding is posed in this case if it is impossible to determine its source with anterior rhinoscopy, if bleeding can not be stopped by a front tamponade, or the patient has a flow of blood into the pharynx without anterior bleeding from the nose,

If a source of bleeding is found, its location should be determined in relation to the middle nasal concha, especially with posttraumatic nosebleeds. If the source of bleeding is above the middle nasal concha, the cause of bleeding is most likely caused by damage to the latticed arteries related to the internal carotid artery system. The location of the bleeding vessel below the middle nasal cone indicates damage to the branches of the inner maxillary artery.

The source of bleeding may be located outside the nasal cavity, for example, in the paranasal sinuses, the nasopharynx, and also in the cavity of the skull. Blood can flow from the nose in esophageal, gastric and pulmonary hemorrhages, which should be differentiated from nasal. A bleeding vessel can be located in the cavity of the skull, as it happens with ruptures of posttraumatic and non-traumatic (infectious) intracavernous aneurysms of the internal carotid artery, with fractures of the trellis plate.

[1], [2], [3], [4]