Mucosal Bleeds - Paediatric Palliative Care
Description General and supportive care Medicine treatment DESCRIPTION Massive bleeds at the end of life, although rare, can occur in several conditions and include: Haematemesis (e.g. bleeding varices, fulminant liver failure). Epistaxis (in haematological malignancies). Haemoptysis (rare in children). Tumour related erosion of blood vessels (less common in children). GENERAL AND SUPPORTIVE CARE
DESCRIPTION
Massive bleeds at the end of life, although rare, can occur in several conditions and include:
- Haematemesis (e.g. bleeding varices, fulminant liver failure).
- Epistaxis (in haematological malignancies).
- Haemoptysis (rare in children).
- Tumour related erosion of blood vessels (less common in children).
GENERAL AND SUPPORTIVE CARE
- If a major bleed is anticipated it is best to be prepared, warn the family about the possibility that this may happen and ensure that they have what they need to manage an emergency: consider providing emergency home packs.
- Major bleeds are often preceded by smaller bleeds.
- In haematological causes associated with thrombocytopenia, platelet transfusions may be used to prevent bleeds up to a point where these no longer work, have to be given frequently or are in short supply. Repeat red blood cell transfusions at the end of life are costly, may not improve quality of life and could postpone dying.
- Have aprons and gloves ready.
- Use dark towels or green surgical sheets to reduce the visual impact of the blood.
MEDICINE TREATMENT
See: Epistaxis.
See: Bleeding oesophageal varices.
For small mucosal bleeds:
- Topical treatment: crushed tranexamic acid tablets or gauze soaked in 100 mg/mL solution for injection.
Bleeding wounds:
- Use topical adrenalin 1:1000 mL on gauze and apply directly to the wound.
In massive bleeds associated with hypotensive shock, consciousness is lost and family/caregiver distress becomes the focus of attention. With slower but large distressing bleeds occurring at the end of life, rapid sedation with benzodiazepines may be required using available routes including IV, SC and rectal (see terminal sedation under end of life care).
Standard Treatment Guidelines And Essential Medicines List For South Africa, Hospital Level, Paediatrics, 2023 Edition
Chapter: 21. Palliative Care, 21.2 Paediatric Palliative Care Emergencies, 21.2.1 Mucosal Bleeds