Epistaxis – nosebleed

Epistaxis (bleeding from the nose) can be extremely concerning for owners and can occur for several reasons with possible resulting complications.

Rabbits suffering from a nosebleed may show one or more of the following clinical signs:

• Bleeding from the nose.
• Sneezing, nasal discharge, staining of the front paws (with blood).
• Loss of appetite.
• Black stools (from digested blood in stools) if swallowing of blood occurs, although this is sometimes more difficult to determine with rabbits since rabbit droppings can appear darker if lots of grass is eaten, as opposed to lighter droppings when hay is eaten.

Bacterial, fungal or viral (rabbit haemorrhagic disease) infection are all potential causes. Other causes can include:

• Tooth root abscesses.
• Foreign body in nose – normally a small piece of hay, grass seed or grass.
• A tumor or growth in the nasal cavity.
• Blood clotting disorders – may be a reaction to anticoagulant chemicals.

It is important that your veterinarian gets to the bottom of the cause of the nosebleed to ensure the correct treatment is given.

Firstly, your veterinarian will perform a clinical examination, as well as consider the history of the problem, eg has it started suddenly, is the rabbit otherwise well, have they had access to chemicals, etc?

Your veterinarian may want to perform other diagnostic tests which may involve:

• Blood work to look at the clotting profile and to check for anemia.
• X-rays are likely to be taken to check for growth or tumours – more detailed imaging such as computed tomography and magnetic resonance imaging may be needed if your veterinarian suspects a problem which may not show up on conventional x-rays.
• Biopsies may be required if any growths are discovered.
• Swabs may be needed for bacterial or fungal testing.

Rabbit viral haemorrhagic disease (RVHD) can cause blood from the nose, mouth and anus. In these circumstances, death is often rapid, and the virus may not be diagnosed until post-mortem.

It is important for your veterinarian to try and stop or lessen the bleeding. Medications can be administered to help with clotting the blood, and fluids may be given to prevent the rabbit from losing too much blood.

Treatment depends on the diagnosis. Bacterial and fungal infections are treated with appropriate antibiotics or antifungal medications.

RVHD in untreatable and a definite diagnosis can only be made on post-mortem samples; this is important if you have other rabbits as the virus is highly contagious.

Foreign bodies can be removed under sedation or general anesthetic. Sometimes endoscopy may be required which may not be available at your veterinary practice and referral may be required.

Growths and tumors may be able to be surgically removed, but is likely to need referral to a specialist surgeon. Cases are all individual and depend greatly on the location and extent of the growth. Sadly, not all will be surgically operable.

Complications depend on the severity of the bleed.

Major nosebleeds can lead to anemia due to the amount of blood lost. If the rabbit inhales some of the blood this can lead to respiratory problems. Rabbits are obligate nasal breathers, ie they breathe through their nose not their mouth, so any blood obstructing the airways could cause respiratory distress.

The rabbit is likely to sneeze due to the irritation and sensation of the blood in the nasal passages.

Many causes of a nosebleed are treatable.

Rabbit with clotting factor problems or those with inoperable tumours that are medically manageable with pain relief and supportive treatment, need close monitoring at home for recurrence of a nosebleed or problems relating to it.