Patients with Severe Aplastic Anaemia who have profound thrombocytopenia (low platelet count) are at increased risk of a life-threatening haemorrhage. Bleeding symptoms can often be spontaneous and commonly occur in the mouth or as a nose bleed.

If you experience a nose bleed at home that does not stop, you should call your haematology team for advice. They may advise you to go straight to your local A&E or haematology day unit, as you may need a platelet transfusion to help stem the bleed.

Whilst these symptoms can be daunting some basic first aid can help minimise the bleeding until you access healthcare.

To help stop a nosebleed:

1. Sit down and firmly pinch the soft part of your nose, just above your nostrils, for at least 10-15 minutes
2. Lean forward and breathe through your mouth – this will drain blood into your nose instead of down the back of your throat

To manage a profound nosebleed in A & E: (for professionals)

1. A set of blood tests should be taken including a full blood count, renal function, coagulation screen and a ‘group and save’

2. Discuss management with haematology registrar on-call

3. Give a platelet transfusion if indicated

4. Consider intravenous tranexamic acid if there is a delay to platelet provision

5. Consider topical medications to anaesthetise the lining of the nose and to constrict blood vessels or the use of a rhino packing - precaution advised if severely neutropenic

Prophylactic platelet transfusions

Some patients require regular platelet transfusions to help prevent bleeding symptoms. The recommended guidelines are to keep your platelet count above 10 x 10^9/L.

Prophylactic platelet transfusions are recommended when:
1. Platelet count is <10 x 10^9/L
2. Platelet count is <20 x 10^9/L, in the presence of fever, infection or bleeding 

You can find more information about platelet transfusions here.

You can order this information as a free booklet, or download a printable PDF here.