What investigations are indicated for a patient presenting with recurrent epistaxis?

For a patient presenting with recurrent epistaxis, initial investigations should focus on identifying underlying causes such as coagulopathies, local nasal pathology, or systemic disease. A full blood count (FBC) is indicated to assess for anaemia and platelet abnormalities, alongside coagulation studies including prothrombin time (PT), activated partial thromboplastin time (aPTT), and possibly von Willebrand factor assays to exclude bleeding disorders ¹. Additionally, a thorough nasal examination, ideally with nasal endoscopy, is essential to identify local sources of bleeding such as septal abnormalities, vascular malformations, or tumours ¹. If initial assessments are inconclusive and bleeding persists, imaging studies such as contrast-enhanced CT or MRI of the paranasal sinuses and nasal cavity may be warranted to detect occult lesions or vascular anomalies (Reyre et al., 2015). In selected cases, especially with severe or refractory epistaxis, referral for angiography can be considered both diagnostically and therapeutically, as arterial embolization has been shown to be effective (Reyre et al., 2015). In children, recurrent epistaxis often requires a similar approach but with careful consideration of common paediatric causes and the role of nurse-led clinics in assessment (Drake et al., 2024). Overall, investigations should be tailored based on clinical history, examination findings, and severity of bleeding, integrating both guideline recommendations and emerging evidence from recent studies ¹; (Reyre et al., 2015; Drake et al., 2024).