Nose Bleeds (Epistaxis) in Cats

By Malcolm Weir, DVM, MSc, MPH; Krista Williams, BSc, DVM; Ernest Ward, DVM

What is epistaxis?

Epistaxis is defined as acute hemorrhage (bleeding) from the nostril, nasal cavity, or nasopharynx (upper part of the throat that lies behind the nose, just above the soft part of the roof of the mouth and just behind the nasal passages). It is commonly referred to as a nosebleed.

Epistaxis in cats can be extremely unsettling for the pet owner. Most acute (sudden) nosebleeds are caused by simple trauma or by upper respiratory tract infections. Other causes of epistaxis in cats can be more serious and require immediate treatment.

What should I do if my cat gets a nosebleed at home?

If your cat begins bleeding from the nose, you can try these simple first aid steps to try to stop the hemorrhage:

  • Keep your cat calm. Elevated blood pressure associated with excitement will increase the bleeding. Stay calm yourself as well, as you getting excited will only upset your cat and drive up their blood pressure.
  • Place an ice pack on the bridge of the nose (on top of the muzzle). In short-faced breeds, be sure your pet can breathe around the ice pack. The cold will constrict small blood vessels, which will slow the bleeding.
  • Do not try to insert absorbent materials like a cotton swab into the nostril, as this will only trigger sneezing, making the nosebleed worse.
  • Do not administer any medication to your cat unless specifically advised to do so by your veterinarian.

If these steps do not stop the bleeding or your cat is having difficulty breathing, see your veterinarian or go to your emergency clinic at once.

Remember that a pet with a bloody nose will likely swallow a great deal of blood. This may lead to a black stool (melena) or vomit that contains blood clots (hematemesis). After an episode of epistaxis, these findings are common and do not necessarily indicate bleeding in the gastrointestinal (GI) tract.

How is it diagnosed?

First, your veterinarian will require a thorough medical history from you. Useful information includes:

  • Has your cat taken or been exposed to any medication in the past thirty days? Non-steroidal anti-inflammatory medications (NSAIDs), especially aspirin, can inactivate blood clotting factors leading to spontaneous Be sure to record all medications and supplements your cat has received.
  • Have you used rat poison or other pesticides in your home or yard?
  • Has your cat eaten or killed any rodents in the past two to three weeks?
  • Has there been any trauma to the nose?
  • Has your cat played roughly with another animal?
  • Is your cat exposed to foxtails, grass awns or other seed heads that could become lodged in the nose?
  • Has your cat been sneezing or rubbing at its nose?
  • Have you seen any blood in the mouth or along the gums?
  • Has your cat had previous nosebleeds?
  • Have you noticed a black tarry stool?
  • Have you noticed any dark, 'coffee-ground' vomit?
  • Have you seen any unusual bruising or darkened areas of skin?
  • Have you noticed any new swelling, lumps or masses on the bridge of the nose?

After the medical history has been evaluated, your veterinarian will perform a physical examination. Specific abnormalities that your veterinarian will look for include:

  • any deformity or asymmetry of your cat's face
  • any swelling of the bridge of the nose
  • elevation of the third eyelids
  • bulging or protruding of one eye when compared to the other
  • excessive tearing of either eye
  • redness of the eyes
  • abnormal appearance of the skin around the nose
  • change in the color of the gums, especially paleness

What sort of tests may be needed?

Based on the exam findings, your veterinarian may recommend one or more of the following tests:

  • Complete blood cell count (CBC) - to search for anemia (low red blood cell count indicates blood loss) and to measure platelets (cells that are necessary for proper clotting)
  • Serum biochemistry - blood tests to assess organ function, searching for evidence of damage to the liver or kidneys from toxins or for other underlying diseases that may cause bleeding
  • Urinalysis - to look for blood in the urine and other abnormalities
  • Clotting tests - a series of tests that assess the function of the various clotting mechanisms in the blood.
  • Radiographs - may be performed to look for evidence of bleeding inside the body or other abnormalities that may result in epistaxis - the chest, skull and oral cavity are often radiographed in cases of epistaxis
  • Blood pressure - high blood pressure can cause nosebleeds
  • Nasal swab - culture and antibiotic sensitivity tests to identify any infectious agents
  • Fungal cultures - cultures to screen for fungal infections in the nasal cavity

More specific tests may be performed based on your cat's initial findings and condition. Examples of additional tests include bone marrow analysis, other fungal tests, tick disease tests, sinus and skull X-rays, MRI, dental examination, and rhinoscopy (viewing the nasal cavities with a small endoscope).

What causes epistaxis?

While there are many causes of epistaxis in cats, the most common causes are trauma and infection. Other more serious conditions that can cause epistaxis include:

  • rodenticide or rat poison
  • liver failure
  • feline leukemia virus infection
  • feline immunodeficiency virus
  • disseminated intravascular coagulation (DIC)
  • immune-mediated thrombocytopenia
  • bone marrow disease
  • drug reactions (methimazole, chemotherapy drugs, estrogens, sulfa class antibiotics)
  • hemangiosarcoma
  • other cancers, especially of the nasal passages and skull
  • fungal diseases
  • Von Willebrand's disease
  • hemophilia

How is epistaxis treated?

Treatment is directed at the underlying condition or primary cause. Antibiotics are often used in cases of infection; surgical cauterization may be used if the condition is chronic. In cases where anxiety is suspected to cause epistaxis, sedatives, tranquilizers, or other behavior-modifying medications may be prescribed.

What is the prognosis?

The prognosis is based on the specific cause of epistaxis and the health status of the pet at the time of diagnosis. Your veterinarian will provide you with detailed diagnostic and treatment plans, as well the prognosis based on your cat’s condition.

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