Swallowed blood from upper respiratory source→ nose bleed
Swallowed blood from oral bleeding site
Meds can exacerbate any of above, including: warfarin, heparin, DOACss, anti-plt agents, or other anti-coagulant agents
Contribution from primary bleeding disorder (e.g.: hemophilia, von Willebrand's disease, other)
Hereditary Hemorrhagic Telangiectasias (HHT): small AVMs that line GI and Respiratory tract, causing chronic low level bleeding (e.g. nose bleeds, slow GI losses)
Symptoms
May report bleeding from a nasal/oral site
May have bleeding from other locations if related to primary bleeding disorder and/or medication
Physical Exam Findings
Evidence of oral, nasal or other bleeding site
Stool can be melenotic, guaiac +
If significant blood/volume loss, can have tachycardia, hypotension
HHT - telangiectasis on tongue, lips, nasal mucosa