The yield of coagulation laboratory screening tests in a patient with epistaxis is relatively low. Tjio et al proposed 4 questions which can help to identify a patient who should or should not have laboratory testing done.
Patient selection: epistaxis
Questions:
(1) past medical history of excessive bleeding including post-surgical that required a blood transfusion
(2) family history of bleeding disorder in 1 first degree relative or 2 second degree relatives
(3) drug history: therapy with antiplatelet drugs or anticoagulants
(4) clinical exam shows signs of a coagulopathy (easy bruisability, bleeding from other sites, stigmata of liver disease, petechiae)
If any of these questions are positive then laboratory testing should be considered.
If none of them are positive then laboratory testing may not be indicated.
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