When In Doubt

If I were to write a book titled, “Pediatric BMT: Caregivers Guide 101”, one of the topics would be: “What to do when your child has a bloody nose that lasts longer than 20 minutes.” Simple. Don’t keep thinking it will stop. Call the hospital and take them in for a platelet transfusion. It’s a no brainer and something I’ve known for years but Wednesday night confused me. It all started at 6 p.m. when Ashtyn’s left nostril started to bleed. That isn’t uncommon and in fact happens daily. The thing that threw us off was that it wouldn’t stop like normal but wasn’t persistent either. It would slowly bleed, clot and stop, then bleed again. Several times I had the phone in my hand to call the team but then it would stop again. I figured her platelets were decent with the clots I saw. Should we go to the hospital? Ashtyn and I could not make up our minds, mostly because she had a platelet transfusion scheduled for 9:40 a.m. and the bleed was so unimpressive. Side note: Ethan had also just arrived in town, which really wasn’t a factor in the decision. Anyways, all night we slept super light, dreaming of nose bleeds and hospitals. By 2 a.m. we regretted our decision to not go to the hospital but by that time it seemed more of a hassle than to just wait until morning. All night was stressful. When she’d get up to the restroom blood would drizzle out. When she laid down the bleeding would stop though I’m now convinced it was slowing going into her stomach. Morning could not come soon enough. At 8:45 a.m. she packed her nose with tissue and we headed out the door for clinic. Once there she wore a face mask so no one could see her nose and got blood labs. Her platelet count was 21 which really wasn’t horrible; sometimes kids don’t get transfusions until less than 10. Her hematocrit was quite low at 21 and her pale skin showed it; blood transfusions are given when her hematocrit is less than 25. We spent 8 hours on Thursday getting a platelet transfusion that stopped the nose bleed and a red blood cell transfusion that gave energy and color to her face. I will say, Wednesday night was super stressful but we kept reminding ourselves that, that particular moment was not going to last forever. Sure enough it didn’t. Lesson learned, when in doubt don’t drag our feet with a nose bleed.