Hemophilia and Glanzmann s thrombastenia are other inherited bleeding disorders that may lead to nosebleeds. Hepatic disease, severe vitamin K deficiency, or malabsortion syndrome is associated with an acquired coagulopathy, which may present with nosebleed. Nosebleeds may be a manifestation of blood vessel disorders, either hereditary or acquired. Vitamin C deficiency, an acquired blood vessel disorder, is associated with nosebleeds. Neoplasms, particularly malignancies, are uncommon causes of nosebleeds in children.
Polyps are usually present in association with cystic fibrosis or allergies.
Capillary, cavernous, and mixed hemangiomas may occur in the nose. Cocaine snorting may cause nasal septal perforation and nosebleeds. The skin and mucous membranes should be checked for petechia, purpura, and ecchymosis. Check the abdomen for hepatosplenomegaly. The oropharynx and nasopharynx should then be inspected for the site of bleeding, for masses and blood dripping downward from a posterior bleed.