[Severe epistaxis in hemorrhagic syndromes (excepting Rendu-Osler disease)]

The existence of a general abnormality in haemostasis causes more copious and protracted haemorrhage but does not, in theory, cause epistaxis. Abnormalities in primary haemostasis are at the root of these serious haemorrhages (thrombocytopenia and Willebrand's disease). Haemophilia is more rarely the trigger for intractable epistaxis. Treatment consists of local measures and replacement therapy. In all cases local treatment should have as little traumatic effect as possible in order to avoid a recurrence of haemorrhage when compression is removed. In women with abnormal constitutional haemostasis, establishment of anovulatory cycles by means of oestro-progestatives prescribed to combat menorrhagia often lessens the seriousness of these epistaxes. Replacement therapy consists of platelet transfusions for thrombocytopenia, the introduction of Willebrand's factor for Willebrand's disease and antihaemophilic factors for haemophilia.