Gelatin-Thrombin Matrix: A New and Simple Way to Manage Recurrent Epistaxis in Hematology Units

Introduction. In case of thrombopenia and/or thrombopathy, epistaxes are very difficult to manage. Case Series. Two patients, one with a thrombocytopenia, the other with a thrombopathy, were hospitalized because of repeated active epistaxes after failure of packing. Both patients were successfully treated with an application of Surgiflo without side effects and left the hospital without recurrence of epistaxis. Discussion. Being a subject of many studies dealing with epistaxis, Surgiflo is a simple treatment that seems to be very effective and without side effects to treat acute epistaxis in fragile patients with coagulation disorders. Prospective studies of tolerance and efficiency in such situations should be performed. 1. Introduction Epistaxes are frequent in adults [1]. Local (e.g., trauma, cancer, etc.), general (e.g., hypertension, anticoagulants; etc.), and idiopathic causes are distinguished [2], and these causes must always be managed. Stopping the blood flow is sequential, applying direct pressure to the nose, followed by anterior packing, then anterior and posterior packing, and finally performing surgical cautery under general anesthesia [3] or endovascular treatment [4]. Surgiflo, a gelatin-thrombin matrix, is being evaluated after endoscopic sinus surgery as an alternative to the painful traditional packing that is painful and traumatic for the nasal mucosa [5]. In hematology, because of thrombocytopenia and/or thrombopathy, epistaxis is more frequent and more difficult to treat due to recurrence. Two patients, one with thrombocytopenia, the other with thrombopathy, were hospitalized for recurrent epistaxis after repeated local treatments failed. Both patients were successfully treated with the application of Surgiflo. 2. Cases Presentation Surgiflo is a dehydrated gelatin-thrombin matrix in a syringe. For endonasale use, its gelatinous consistency must be maintained to remain in the nasal cavity (reconstitution with up to 3.5 to 4？mL of sterile water). A 16？cm-long applicator is put through the nasal vestibule to the nasopharynx. Patient must make a “ke-ke-ke” sound continuously so that the soft palate joins the posterior pharyngeal wall and excludes the nasopharynx from the oropharynx. The rhinopharynx and the nasal cavity are filled in with Surgiflo from back to front. 2.1. Patient No. 1 Mr. C, 58 years old, was hospitalized for a bilateral anterior and posterior epistaxis. He was treated with 5-azacytidin in the Hematology Unit of HIA Desgenettes for type 2 myelodysplastic syndrome with refractory anemia and excess blasts. Even with