Can We Estimate the Recurrence of Epistaxis with Simple Blood Tests?

J Clin Exp Invest 2020;11(2):em00735.

Article views: 133 Article downloads: 117


Download Full Text (PDF)


Objective: Epistaxis is often treated in the emergency department (ED) and is one of the causes of bleeding that can be successfully managed by physicians. This study aimed to investigate whether there is a relationship between recurrent epistaxis and simple blood parameters (the values of mean platelet volume (MPV) and red cell distribution width (RDW)).
Method: This retrospective case-control study was designed at a tier-three ED. The patients were chosen from among those who applied to the ED for epistaxis between 1 January 2018 and 31 December 2018. Demographic data, seasonal application frequency, complete blood count results and clinical findings were retrospectively reviewed on the hospital information record system. The patients were categorized into three groups of recurrent epistaxis, non-recurrent epistaxis and healthy control groups.
Results: 143 epistaxis patients in total including recurrent (n=73) and non-recurrent (n=70) patients were enrolled in this study. The healthy control group was composed of 77 patients. The MPV value was significantly higher in the recurrent epistaxis group than in the non-recurrent epistaxis group (8.91±1.16, 8.48±1.06, P = 0.006, respectively). In addition, the mean platelet and platecrit values were significantly higher in the non-recurrent epistaxis group than in the recurrent epistaxis group (P = 0.034, P = 0.043, respectively). The high RDW level was found to be statistically significant both in the recurrent and non-recurrent epistaxis groups than in the control group (P < 0.001). The logistic regression analysis concluded that the high MPV value increased epistaxis 1.367 times [OR: 1.367 (0.952-1.963), P = 0.028].
Conclusion: High MPV levels caused an increase in the bleeding tendency in the patients with recurrent epistaxis.


recurrent epistaxis, mean platelet volume, emergency department


  • Addison A, Paul C, Kuo R, Lamyman A, Martinez-Devesa P, Hettige R. Recurrent epistaxis: predicting risk of 30-day readmission, derivation and validation of RHINO-ooze score. Rhinology. 2017;55:99-105.
  • Chaaban MR, Zhang D, Resto V, Goodwin JS. Factors influencing recurrent emergency department visits for epistaxis in the elderly. Auris Nasus Larynx. 2018;4:760-4.
  • Karabulut AE, Çevik Y, Emektar E, Çorbacioğlu ŞK, Dağar S, Yardim O. Analysis of mean platelet volume and red blood cell distribution width in recurrent epistaxis. Turk J Emerg Med. 2018;18:67-70.
  • Adoga AA, Kokong DD, Mugu JG, Okwori ET, Yaro JP. Epistaxis: The demographics, etiology, management, and predictors of outcome in Jos, North-Central Nigeria. Ann Afr Med. 2019;18:75-9.
  • Kovács S, Csiki Z, Zsóri KS, Bereczky Z, Shemirani AH. Characteristics of platelet count and size and diagnostic accuracy of mean platelet volume in patients with venous thromboembolism. A systematic review and meta-analysis. Platelets. 2019;30:139-47.
  • Patti G, Di Martino G, Ricci F, et al. Platelet Indices and Risk of Death and Cardiovascular Events: Results from a Large Population-Based Cohort Study.Thromb Haemost. 2019;119:1773-84.
  • Zhang Q, Cao X, Zhou J, et al. Red cell distribution width reflects the early stage residual renal function in peritoneal dialysis patients. Saudi J Kidney Dis Transpl. 2018;29:1082.
  • Huang YL, Han ZJ, Hu ZD. Red blood cell distribution width and neutrophil to lymphocyte ratio are associated with outcomes of adult subarachnoid haemorrhage patients admitted to intensive care unit. Ann Clin Biochem. 2017;54:696-701.
  • Ćatić J, Jurin I, Lucijanić M, Jerkić H, Blažeković R. High red cell distribution width at the time of ST segment elevation myocardial infarction is better at predicting diastolic than systolic left ventricular dysfunction: A single-center prospective cohort study. Medicine. 2018;97:601.
  • Lam M, Roszik J, Kanikarla-Marie P, et al. The potential role of platelets in the consensus molecular subtypes of colorectal cancer. Cancer Metastasis Rev. 2017;36:273-88.
  • Cooper SE, Ramakrishnan VR. Direct cauterization of the nasal septal artery for epistaxis. Laryngoscope. 2012;122:738-40.
  • Pallin DJ, Chng YM, McKay MP, Emond JA, Pelletier AJ, Camargo Jr CA. Epidemiology of epistaxis in US emergency departments, 1992 to 2001. Ann Emerg Med. 2005;46:77-81.
  • Chaaban MR, Zhang D, Resto V, Goodwin JS. Demographic, seasonal, and geographic differences in emergency department visits for epistaxis. Otolaryngol Head Neck Surg. 2017;156:81-6.
  • Abrich V, Brozek A, Boyle TR, Chyou PH, Yale SH. Risk factors for recurrent spontaneous epistaxis. Mayo Clin Proc. 2014;89:1636-43.
  • Ando Y, Iimura J, Arai S, et al. Risk factors for recurrent epistaxis: importance of initial treatment. Auris Nasus Larynx. 2014;41:41-5.
  • Bohec P, Gachelin J, Ollivier V, et al. Acoustophoretic purification of platelets: Feasibility and impact on platelet activation and function. Platelets. 2019;30:174-80.
  • Ju HY, Kim JK, Hur SM, et al. Could mean platelet volume be a promising biomarker of progression of chronic kidney disease? Platelets. 2015;26:143-7.
  • Sansanayudh N, Muntham D, Yamwong S, Sritara P, Akrawichien T, Thakkinstian A. The association between mean platelet volume and cardiovascular risk factors. Eur. J. Intern. Med. 2016;30:37-42.
  • Liu X, Wang S, Yuan L, et al. Increased Mean Platelet Volume is Associated with Higher In-Hospital Mortality Rate in Patients with Acute Myocardial Infarction. Clin Lab. 2017;63:163-7.
  • Chu S, Becker R, Berger P, et al. Mean platelet volume as a predictor of cardiovascular risk: a systematic review and meta‐analysis. Thromb Haemost. 2010;8:148-56.
  • Budak YU, Huysal K, Demirci H. Correlation between mean platelet volume and B-type natriuretic peptide concentration in emergency patients with heart failure. Biochem Med. 2015;25:97-102.
  • Goel A, Saini S, Moinuddin A, et al. Mean platelet volume and mean platelet volume/platelet count ratio commensurate to severity in ischemic stroke. Int J Neurosci. 2018;6:6-10.
  • Gokce S, Kurugol Z, Suner A. The role of mean platelet volume in the early detection of acute bronchiolitis: A prospective study. Clin Respir J. 2018;12:2513-8.
  • Bath P, Algert C, Chapman N, Neal B. Association of mean platelet volume with risk of stroke among 3134 individuals with history of cerebrovascular disease. Stroke. 2004;35:622-6.
  • Vizioli L, Muscari S, Muscari A. The relationship of mean platelet volume with the risk and prognosis of cardiovascular diseases. Int J Clin Pract. 2009;63:1509-15.
  • Kara H, Degirmenci S, Bayir A, et al. Red cell distribution width and neurological scoring systems in acute stroke patients. Neuropsychiatr Dis Treat. 2015;11:733.
  • Wonnerth A, Krychtiuk KA, Mayer FJ, et al. Red cell distribution width and mortality in carotid atherosclerosis. Eur J Clin Invest. 2016;46:198-204.
  • Goyal H, Lippi G, Altin Gjymishka BJ, Chhabra R, May E. Prognostic significance of red blood cell distribution width in gastrointestinal disorders. World J Gastroenterol. 2017;23:4879.
  • Ozkok A, Nesmith BL, Schaal S. Association of Red Cell Distribution Width Values with Vision Potential in Retinal Vein Occlusion. Ophthalmol Retina. 2018;2:582-6.
  • Kemal O, Müderris T, Sevil E, Kutlar G. Relation of mean platelet volume and red blood cell distribution width with epistaxis. Laryngoscope. 2015;125:788-90.
  • Qin B, Ma N, Tang Q, et al. Neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) were useful markers in assessment of inflammatory response and disease activity in SLE patients. Mod Rheumatol. 2016;26:372-6.
  • Kim DS, Shin D, Lee MS, et al. Assessments of neutrophil to lymphocyte ratio and platelet to lymphocyte ratio in Korean patients with psoriasis vulgaris and psoriatic arthritis. J Dermatol. 2016;43:305-10.
  • Aksakal C, Şahin M. Evaluation of neutrophil/lymphocyte ratio and platelet/lymphocyte ratio in recurrent epistaxis in childhood: case controlled study. Pan Afr Med J. 2019;32:154.


Korkut M, Bedel C, Karancı Y, Duyan M. Can We Estimate the Recurrence of Epistaxis with Simple Blood Tests?. J Clin Exp Invest. 2020;11(2):em00735.