Recurrent nosebleeds are one common symptom of leukemia. Also known as epistaxis, these nosebleeds are often experienced with other types of abnormal bleeding, such as bleeding in the gums and bruising more easily than usual.

If you have experienced frequent or severe nosebleeds with leukemia, you may be wondering why they occur. Read on to learn more about why nosebleeds may affect people with leukemia, as well as how they can be managed. As always, talk to your doctor if you experience any new or worsening leukemia symptoms.

How Do People With Leukemia Experience Nosebleeds?

Many MyLeukemiaTeam members have shared their concerns about frequent or heavy nosebleeds. “My nose was bleeding when I woke up, and that scares the crap out of me,” wrote one member. “I’ve had nosebleeds surprisingly frequently,” another added.

Nosebleeds may be worrying or frustrating, especially if they appear or worsen seemingly out of the blue. As one member asked others, “Is anyone here experiencing night sweats and/or nosebleeds?? They both have gone from bothersome to being a nuisance!” “Last week, for some reason, I started to get nosebleeds,” another member recalled. “The first was nothing major, but the second happened while I was sleeping, and there was a lot of blood on my pillow and on me. Tonight, it started around 7 p.m. and didn’t stop until 10 p.m. Freaked me out. Never had these before, and why I’m getting them now is a mystery.”

Others, like one member who wrote that they had “never had a major nosebleed,” find other types of abnormal bleeding more concerning. This member added that they “did have a few minor nosebleeds. I did have a very serious gum bleed that put me in the hospital for six days. It took them four days to slow the bleed and another day to completely stop the bleed.”

Some members find that their nosebleeds come and go, often occurring when their blood platelet counts are low. “I had nosebleeds when my platelets were low,” shared one member, “along with red spots all through my mouth. As soon as I got platelets, all was fine.”

As one member noted, it’s important to let your oncologist or health care team know if you start experiencing new or worsening nosebleeds. “I hope you have let your doctor know about the nosebleeds,” the member advised. “That could be a sign of something they need to know.”

What Can Cause Nosebleeds in Leukemia?

Leukemia can cause the body to make fewer platelets, which leads to a higher risk of bleeding.

There are several reasons why you may experience more frequent or heavier nosebleeds than usual while living with leukemia. This includes symptoms of leukemia, as well as side effects of leukemia treatments.

Low Blood Platelet Count and Clotting Problems

Platelets are a type of blood cell that helps the blood clot (stick together) after an injury. In leukemia, cancerous cells multiply and eventually crowd out the body’s healthy blood cells. This can lead to low red and white blood cell counts, as well as a low platelet count, called thrombocytopenia.

Having lower-than-normal platelet counts affects the blood’s ability to clot, resulting in symptoms like bruising, excessive bleeding, and severe or frequent nosebleeds. Aside from nosebleeds, people with thrombocytopenia may also experience heavy menstrual periods or bleeding gums.

Several different types of leukemia can cause thrombocytopenia, including chronic lymphocytic leukemia, acute lymphoblastic leukemia, acute myeloid leukemia, and hairy cell leukemia. Another type of leukemia known as acute promyelocytic leukemia can also affect the blood’s ability to clot, leading to frequent bleeding or severe nosebleeds.

Treatments for Leukemia

Like leukemia itself, leukemia treatments can reduce the blood’s platelet count. If chemotherapy lowers the number of platelets in your blood, your oncology team may recommend a platelet transfusion to increase your blood platelet count.

Other Potential Causes of Nosebleeds

You may develop nosebleeds that are unrelated to leukemia or its treatments. Other potential causes of nosebleeds include:

• Weather or humidity changes that dry out the inside of the nose
• Picking or injuring the skin inside the nose
• Blowing your nose too hard

All these factors may damage the small, delicate blood vessels inside the nose. In some cases, however, the blood vessels deeper inside the nose may start to bleed. This can occur as the result of a head injury, nasal surgery, or atherosclerosis (the hardening and buildup of deposits within the arteries).

Managing Nosebleeds With Leukemia

There are several ways of managing and treating the underlying causes of nosebleeds with leukemia. As with any leukemia symptom, talk to your health care provider if you develop new or worsened nosebleeds. They can work with you to identify the cause and find the best way of managing or treating the condition.

Treat Your Leukemia

In the case of excessive bleeding caused by leukemia, treating the underlying cancer may help raise your platelet count enough to reduce or eliminate nosebleeds. There are many different treatment options for leukemia, including chemotherapy, targeted therapies, immunotherapy, and radiation therapy. The treatments your doctor will recommend depend on which type of leukemia you have.

Treatments for Thrombocytopenia

If thrombocytopenia is causing frequent or severe nosebleeds, your doctor may recommend receiving platelet transfusions or taking medications to help raise your platelet count. These may be administered alongside other thrombocytopenia treatments, such as medications to help suppress immune system activity.

Stopping Nosebleeds

If you experience a nosebleed, the NHS recommends taking the following steps to stop it:

• Sit down and firmly pinch the soft area above your nostrils for a minimum of 10 to 15 minutes.
• Lean forward while breathing through your mouth. This allows your blood to drain forward into your nose, rather than down your throat.
• Apply a cold pack or frozen peas wrapped in a towel to the bridge of your nose.
• Avoid lying down — instead, remain upright to help minimize pressure in your nose’s blood vessels and reduce bleeding.

When To Seek Medical Treatment

If the above steps help stop your nosebleed, you may not require medical treatment. You should seek medical care if:

• You are taking an anticoagulant (blood thinner) or have a blood-clotting disorder and the bleeding does not stop.
• You have frequent nosebleeds.
• You show signs or symptoms of anemia (low red blood cell count), like shortness of breath, pale skin, or heart palpitations.
• A child younger than two years old is experiencing a nosebleed.

You should call 911 or go to the emergency room if:

• Your nosebleed does not stop after 20 minutes.
• Your nose is bleeding heavily and you have lost a lot of blood.
• You swallow enough blood to cause you to vomit.
• You are having trouble breathing.
• You develop a nosebleed after a serious injury, like a car accident.

Find Your Team

Are you or a loved one living with leukemia? You don’t have to go it alone. On MyLeukemiaTeam, you’ll find a network of more than 12,500 members from around the world who understand life with leukemia. Here, you can ask questions, offer support and advice, and build a team of others who will be by your side throughout your journey.

Have you experienced nosebleeds as a leukemia symptom? How have you managed them? Share your thoughts or tips in the comments below or by posting on MyLeukemiaTeam.