Nasal Packing with Strips of Cured Pork as Treatment for Uncontrollable Epistaxis in a Patient with Glanzmann Thrombasthenia

Objectives: Glanzmann thrombasthenia is a rare disorder of platelet function that may result in life-threatening hemorrhage, particularly from the nasal vaults. Various medical therapies (such as recombinant factor VII, antifibrinolytic agents, and blood transfusions) and surgical therapies (such as nasal packing, electrocautery, laser coagulation, septoplasty, and embolization) have been described with various degrees of success. Methods: We present a unique case report of a 4-year-old child with known Glanzmann thrombasthenia and two separate episodes of life-threatening epistaxis that were treated successfully by nasal packing with strips of cured pork because of special circumstances. Results: Cured salted pork crafted as a nasal tampon and packed within the nasal vaults successfully stopped nasal hemorrhage promptly, effectively, and without sequelae. In both applications, the patient had complete cessation of nasal bleeding within 24 hours, and was discharged within 72 hours after treatment. Conclusions: To our knowledge, this represents the first description of nasal packing with strips of cured pork for treatment of life-threatening hemorrhage in a patient with Glanzmann thrombasthenia.

Is the nasal tampon a suitable treatment for epistaxis in Accident & Emergency? A comparison of outcomes for ENT and A&E packed patients

This retrospective observational study aimed to establish the outcome for patients packed with a nasal tampon as first-line therapy for epistaxis in Accident & Emergency compared to those packed by ENT. During our study period, 189 admissions were treated with a nasal tampon as first-line therapy; 89 were inserted by ENT and 100 by A&E. A significantly higher number of patients packed by A&E required further treatment to control bleeding (p = 0.004; 95 per cent CI 7–34) than those in the group packed by ENT. A significantly greater proportion from the A&E group required additional cautery alone to control bleeding (p = 0.005; 95 per cent CI 5–30). We suggest that this may be due to inadequate initial assessment and inappropriate first-line therapy in the A&E department. It is recommended that ENT review patients prior to packing, in order to reduce the morbidity associated with multiple treatments.