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Nasal and gum bleeding in one with history of HLA B27 positive - Online Doctor Chats

Date : 21-Feb-2012
User rating for this question
Good Posted in: Blood Disorders
Answered by

General & Family Physician
Practicing since : 2005
Answered : 2408 Questions
User :   Hi,I've noticed blood (coagulated) in nose and bleeding gums when brushing teeth in the morning after moderate alcohol consumption last evening. I am ocational alcohol consumer, usualy 4-5 times a month in small amounts (0,5 liter of beer, glass of wine), larger amounts being rare and resulting in symptoms I describe.
Doctor :   Hi
Doctor :   May I know your age and gender?
Doctor :   Since when have you noticed these symptoms?
User :   I have other conditions which could be related. I am 26 years old now (male) and 14 year ago I had hemorhage in my brain after angioma bursted.
User :   I think I've notice them only for the third time, during last half year
Doctor :   Ok.
Doctor :   Approximately how much of bleeding have you noticed?
User :   After the angioma was located doctors tried to look for Osler-Rendu-Weber syndrome, because I had teliaangectasis on my face.
User :   But it was never confirmed.
Doctor :   Ok
User :   It was maybe 3 mililiters of coagulated blood.
User :   Bleeding gums is also not comon for me.
Doctor :   How often are you getting the bleeding gums?
Doctor :   Have you seen a doctor for the evaluation of recurrent bleeding gums?
User :   Such that I would notice - very rarely, exactly at the same times I have blood in nose. Usualy the saliva is sometimes a little bit pink after brushing teeth, but this morning (I've noteced this this morning last time) it was red.
User :   No, I haven't seen the doctore yet regarding this.
Doctor :   Ok
Doctor :   Are you on any medications?
Doctor :   Do you have joint pains?
User :   Yes, sometimes I have joint pains
User :   They are not severe, but I started feeling mild (very, barely noticeble) joint paint in all my finger.
Doctor :   Ok
User :   I have rheumatoidal arhtritis history in my family.
Doctor :   Do you have swelling of the joints?
User :   And I am Human Leucocyte Antigen 27 positive.
User :   No, I don't think they are swollen.
Doctor :   Ok
Doctor :   Have you had seen bleed in the urine, stools in the past?
User :   I was also diagnosed Crohn's desease (this is why I did HLA-B27 test), but after last colonoscopy they have taken Crohn's diagnosis away and left Irritable Bowel Syndrome.
User :   No blood in urine or stools (suspectible only one case of blood in stool, few years ago)
Doctor :   Ok
Doctor :   Any one else in the family has/had similar symptoms?
User :   If you mean blood in the nose and bleeding gums related with alcohol consumption - I have not heard anybody in my family complain about that.
Doctor :   Ok.
Doctor :   Let me explain it to you.
Doctor :   HLA B27 is associated with connective tissue disorder.
Doctor :   Connective tissue disorders do not cause bleeding.
User :   What if blood vessels become weaker (as I understand, they are partly made of connective tissue)?
User :   Other thing - I get marks on my skin easily - if I twist my skin, marks apear, because of blood vessel breakage.
Doctor :   Which part of the blood vessel has become weak?
User :   I have no idea :) This is just an assumption - because I see marks on my skin after bumps, bruises, etc. A lot more easy to get then for most other people.
Doctor :   HLA B27 is commonly associated with arthritis, uveitis, iritis, ulcerative colitis.
Doctor :   And not all connective tissue disorders.
User :   yes, any inflamatory bowel desease - my doctors tried to differentiate between ulcerative colitis and Crohn's - and biopsies showed Crohn's, but last endoskopy showed NO ulcers/erosions at ALL.
Doctor :   Blood vessel breakage will lead to bleeding and hematoma formation and not just simple marks.
User :   I am trying to find if there is some one major underlying cause for many of my symptoms.
Doctor :   So the marks you may be getting may not be due to vessel breakage.
User :   What could be other causes?
Doctor :   Spontaneous bleeding are associated with few of the local problems such as
Doctor :   inflammatory conditions,
Doctor :   Trauma,
Doctor :   Systemic conditions such as anemia,
Doctor :   thrombocytopenia,
Doctor :   liver conditions,
Doctor :   bleeding disorder and few other rare disorders.
Doctor :   Not to forget hypertension too.
User :   what liver conditions could that be? I also have small red dots on my skin and had liver problems in my childhood.
Doctor :   Liver problems most commonly cirrhosis
User :   Hypertension to be taken out of the list, at least for now - ~130/80 usualy, but was 120/80 couple of years ago.
User :   What are these "other rare", just to read more about them?
Doctor :   From the brief history that you have provided, I would suggest you to get a few tests to know if any of these causes may be causing your symptoms.
Doctor :   Other rare causes include Ehlers Danlos syndrome, hemophillia, hypofibrinogenemia,
Doctor :   Are you there?
Doctor :   It seems you have moved out of the chat window. Please log in back if you have medical queries.
Doctor :   Are you there?
User :   Sorry
User :   had to recharge
Doctor :   Yes, the list of other rare cause that could cause these bleeding includes,
User :   What kind of test would you suggest?
Doctor :   hemorrhagic telengectasia, vitamin c deficiency and so on.
User :   Hemophillia - definitely NO
Doctor :   Hence I would suggest you these tests.
Doctor :   1. Complete blood count that should also include the platelet count particularly.
Doctor :   2. Bleeding time and clotting time
Doctor :   *Coagulation profile
Doctor :   3. Liver function test
Doctor :   These are the few basic tests that may be needed.
User :   Ok, thanks, will do them. I have changed my diet a year ago - I have stopped eating meat (before that I was not eating red meat for a year maybe, only puoltry mostly) and I am wondering if these new symptoms could be related to some kind of deficiency (I am not vegetarian, I eat a lot of fish, eggs, diary)
Doctor :   These tests are to rule out few of the commonest systemic causes.
Doctor :   Since your symptoms are located only to the gums and the nose, it probably may be related to only local factors and not systemic factors and not the dietary modifications too.
Doctor :   The most probable causes according to your history may be
Doctor :   inflammatory conditions such as gingivitis or telengectasia.
User :   Thanks. Any recomendations for deficencies (by sampling blood)?
Doctor :   You can follow few simple measures till then
Doctor :   1. Adequate diet that must include plenty of vegetables, fruits especially citrus fruits.
Doctor :   2. Avoid nose picking ( if any)
Doctor :   3. Use soft bristle tooth brush.
Doctor :   4. Twice brushing and flossing
Doctor :   5. Apply saline water to the affected gums or alternatively you may use warm salt water while gargling following brushing.
User :   Thanks, I think I eat a lot of vegetables, fruits - squize fresh citrus juice several times a weak. No nose picking except when cleaning nose in the morning, using soft tooth brush. Will try saline water.
Doctor :   6. Restrict alcohol consumptions (heavy alcohol can lead to or aggravate liver problems)
Doctor :   7. If problems aggravate, then see you local GP for examination.
Doctor :   Have you followed?
User :   Yes, I will have to restrict those rare cases I consume more alcohol, although I consider myself trying to avoid alcohol.
User :   Yes, thanks, will try to do what you said.
Doctor :   Do you have any other query that I can assist you with?
Doctor :   Please also fill the feedback form and say when done.
User :   Not currently, might get back with my blood tests.
Doctor :   Sure, you may do that.
User :   Thanks, bye
Doctor :   Thanks for consulting me. Bye for now. Please refer your friends to our service.
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