BASICS
- Caused by lesions within the respiratory tract but can be secondary to hemostatic dysfunctions (rare)
- Unilateral discharge—often lesions rostral to the nasopharynx
- Bilateral discharge—often lesions caudal to the nasopharynx or from hemostatic dysfunctions
- Systems affected—respiratory and hemic
- Blood trickle at the nostril(s) to severe hemorrhage
- Unilateral trickle; upper respiratory origin; nasal passage, turbinates, or paranasal sinuses. Sometimes ipsilateral guttural pouch hemorrhage
- Bilateral trickle or severe hemorrhage; origin caudal to the nasopharynx (guttural pouch, lower respiratory tract) or hemostatic disorders
- Mucopurulent or foul-smelling discharges suggest an infectious or necrotic origin
- Bilateral frothy discharge is consistent with pulmonary edema
- Thrombocytopenia and DIC often are associated with mucosal petechiation, prolonged bleeding from venipuncture sites, and occult blood from the GI or urinary tracts
- Hemostatic dysfunction—thrombocytopenia, DIC, coagulation factor deficiency, or envenomation
- Respiratory tract disease—upper respiratory disease may result from primary bacterial or fungal infections (guttural pouch mycosis, sinusitis), neoplasia or idiopathic diseases (nasal polyp, nasal amyloidosis, ethmoid hematoma). Lower respiratory diseases include EIPH, pleuropneumonia, pulmonary edema, lung neoplasia
- Trauma—nasal intubation, fractures, longus capitis muscle rupture secondary to falling backward, and lung biopsy
- Other—vasculitis (purpura haemorrhagica), fibrous dysplasia, periocular bleeding
DIAGNOSIS
TREATMENT
MEDICATIONS
FOLLOW-UP
MISCELLANEOUS