Epistaxis Due to Platelet Dysfunction in a Healthy Person During Office Reconstruciton

A healthy 63-year-old male developed severe unprovoked recurrent nose bleeding over a 40-day period. He had no other symptoms and his past-medical and family histories were non-contributory. His physical examination, complete blood counts, and coagulation profile were normal. Three weeks into the illness, a platelet function screen was found abnormal. Hematology consultation did not find a cause for his thrombasthenia. After a short hospitalization for severe epistaxis, recurrent nosebleeds stopped. Several months later, the platelet function screen was normal. Post-hoc review of history found that the onset and duration of his nose bleeding and platelet dysfunction coincided with office reconstruction, which generated a strong aromatic smell. He was physically closer to the reconstruction site than unaffected co-workers. There was a temporal relation between the intensity of exposer to office environment and the intensity of bleeding. It is probable that the cause of his platelet dysfunction was an inhaled unidentified toxic chemical(s). The management of his epistaxis and risk of inhalation of toxins as a cause of platelet dysfunction are discussed.