A patient with recurrent bilateral epistaxis has mucocutaneous telangiectasia and a first-degree relative with similar symptoms. What is the most appropriate broader management principle?
HHT is multisystem disease. Nasal cautery alone does not address pulmonary, cerebral or hepatic vascular complications, anaemia or family counselling.
A. Treat only with repeated unilateral silver-nitrate cautery: Repeated focal cautery may worsen septal injury and misses systemic risk.
B. Assume an isolated local nasal disorder: The family history and telangiectasia point to inherited systemic disease.
C. Assess within a multidisciplinary HHT pathway for systemic arteriovenous-malformation risk as well as nasal bleeding: HHT is multisystem disease. Nasal cautery alone does not address pulmonary, cerebral or hepatic vascular complications, anaemia or family counselling.
D. Start long-term oral anticoagulation: This is not a treatment for HHT-related epistaxis.
E. Ignore iron studies unless shock develops: Chronic blood loss and anaemia need active assessment.
If the history lacked telangiectasia and family pattern, common local causes of epistaxis would be reconsidered.
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