As the ENT SHO you take direct admissions from the Emergency Department’s triage nurse for anything ENT related.  You get a call about a 35 year old gentleman who has had on-and-off epistaxis for the past 24 hours and is getting worse.  The A&E nurse has kindly taken some baseline bloods and the patient is taken to the ENT ward for packing after initial ABC was okay.

The lab call the ward soon after arrival with a provisional FBC:

• Hb 100g/l (i.e. 10.0g/dL) (ref 130-180)
• MCV 95fL (ref 82-98)
• WCC 12.5×10*9/L (ref  4-11)
• Platlets 21×10*9/L (ref 150-450)

Please answer the following question(s)

1. What are your differential diagnoses?
2. What is your initial management?

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