What is epistaxis?
Epistaxis is bleeding from the nostril, nasal cavity, or nasopharynx — the upper part of the throat, behind the nose, just above the soft part of the roof of the mouth and just behind the nasal passages. Epistaxis is commonly called a nosebleed. It can be acute (sudden) or chronic (persistent).
What should I do if my cat gets a nosebleed?
If your cat begins bleeding from the nose, try these simple first aid steps to stop the hemorrhage:
- Keep your cat calm. Excitement elevates blood pressure and increases the bleeding. Keep yourself calm, as well, to help reduce your pet’s anxiety.
- Place an ice pack on the bridge of the nose (on top of the muzzle). The cold constricts small blood vessels, slowing the bleeding. In short-faced breeds, be sure your pet can breathe around the ice pack.
- Do not insert absorbent materials into the nostrils (e.g., a cotton swab), as this will only trigger sneezing, making the nosebleed worse.
- Do not give your cat any medication unless your veterinarian advises you to do so.
If these steps do not stop the bleeding or your cat is having difficulty breathing, see your veterinarian or go to your emergency clinic immediately. Remember that a cat with a bloody nose will likely swallow a lot of blood, which may lead to a black stool (melena) or vomit that contains blood clots (hematemesis). After an episode of epistaxis, these findings are common and do not necessarily indicate bleeding in the gastrointestinal (GI) tract.
What causes epistaxis?
While there are many causes of epistaxis in cats, the most common causes are trauma and infection. Other serious conditions that can cause epistaxis include:
- Rodenticide or rat poison
- Liver failure
- Feline leukemia virus infection
- Feline immunodeficiency virus
- Disseminated intravascular coagulation (DIC) (type of blood clotting disorder)
- Immune-mediated thrombocytopenia
- Bone marrow disease
- Drug reactions (methimazole, chemotherapy drugs, estrogens, sulfa class antibiotics)
- Fungal diseases
- Von Willebrand disease
- Hemophilia
- Hemangiosarcoma
- Other cancers, especially of the nasal passages and skull
How is epistaxis diagnosed?
To diagnose epistaxis, your veterinarian will require a thorough medical history for your cat. Useful information includes:
- Has your cat taken or been exposed to any medication in the past 30 days, including accidental ingestion? Nonsteroidal anti-inflammatory medications (NSAIDs), especially aspirin, can inactivate blood clotting factors, leading to spontaneous bleeding. Be sure to record all medications and supplements your cat receives.
- Have you used rat poison or other pesticides in your home or yard?
- Has your cat eaten or killed any rodents in the past two to three weeks?
- Has there been any trauma to the nose?
- Has your cat played roughly with another animal?
- Is your cat exposed to foxtails, grass awns, or other seed heads that could become lodged in the nose?
- Has your cat been sneezing or rubbing its nose?
- Have you seen any blood in the mouth or along the gums?
- Has your cat had previous nosebleeds?
- Have you noticed a black, tarry stool?
- Have you noticed any dark vomit that looks like coffee grounds?
- Have you seen any unusual bruising or darkened areas of skin?
- Have you noticed any new swelling, lumps, or masses on the bridge of the nose?
After your veterinarian evaluates your cat’s medical history, they will perform a physical examination. Specific abnormalities that your veterinarian will look for include:
- Any deformity of your cat's face or lopsidedness of your cat's face
- Any swelling of the bridge of the nose
- Elevation of the third eyelids
- Bulging or protruding of one eye when compared to the other
- Excessive tearing of either eye
- Redness of the eyes
- Abnormal appearance of the skin around the nose
- Change in gum color, especially if they seem pale
What tests may be needed?
Based on the exam findings, your veterinarian may recommend one or more of the following tests:
- Complete blood cell count (CBC): To search for anemia (low red blood cell count indicates blood loss) and to measure platelets (cells that are necessary for proper clotting)
- Serum biochemistry: Blood tests to assess organ function and search for evidence of damage to the liver or kidneys from toxins or for other underlying diseases
- Urinalysis: To look for blood in the urine and other abnormalities
- Clotting tests: To assess the function of various clotting mechanisms in the blood
- Radiographs (X-rays): To look for evidence of bleeding inside the body or other abnormalities that may result in epistaxis; often the chest, skull, and oral cavity
- Blood pressure: To determine whether high blood pressure is causing the nosebleed
- Nasal swab: To use in culture and antibiotic sensitivity tests to identify any infectious agents
- Fungal cultures: To screen for fungal infections in the nasal cavity
Your veterinarian may perform more specific tests based on their initial findings and your dog’s condition. Additional tests may include bone marrow analysis, other fungal tests, tick-borne disease tests, sinus and skull X-rays, MRI, dental examination.
How is epistaxis treated?
Treatment is directed at the underlying condition or primary cause. Antibiotics are often used in cases of infection. If the condition is chronic, your veterinarian may use surgical cauterization (seal the blood vessels using heat). In cases where anxiety is suspected to cause epistaxis, your veterinarian may prescribe sedatives, tranquilizers, or other behavior-modifying medications.
What is the prognosis?
The prognosis is based on the specific cause of epistaxis and the health status of the pet at the time of diagnosis. Your veterinarian will provide you with detailed diagnostic and treatment plans, as well as the prognosis based on your cat’s condition.
