Correspondence (letter to the editor): Manifestation of a Congenital Disorder

Many thanks for the detailed and successful article on the topic of epistaxis. Please allow me to express a point of criticism, however: although coagulopathies were mentioned among the causes of epistaxis (the syndrome is no longer called “Willebrand-Jürgens syndrome”, but is known as “von Willebrand syndrome”), hemostaseological diagnosis and treatment are neither included in the algorithm (Figure 2) nor are they mentioned in the list of CME questions (1). Repeated nosebleeds, especially if common in entire families (the family medical history was also omitted) may be the manifestation of a congenital or acquired disorder and, not least in view of future surgical interventions, should be investigated hemostaseologically. With a prevalence of 1%, the von Willebrand syndrome is not rare and may require treatment with desmopressin, tranexamic acid, or von Willebrand factor concentrate. Acquired thrombocytopenia—for example, in the context of immunothrombocytopenia—is not rare as well and is associated with substantial risks and consequences that vastly exceed local management. A relevant addition to the algorithm and the CME questions is advisable.