title: Dietary supplement use and nosebleeds in hereditary haemorrhagic telangiectasia - an observational study.
abstract: Understanding potential provocations of haemorrhage is important in a range of clinical settings, and particularly for people with abnormal vasculature. Patients with hereditary haemorrhagic telangiectasia (HHT) can report haemorrhage from nasal telangiectasia in real time, and suggested dietary factors may precipitate nosebleeds. To examine further, nosebleed severity, dietary supplement use, and blood indices were evaluated in an unselected group of 50 HHT patients recruited from a specialist UK service. Using the validated Epistaxis Severity Score, nosebleed severity ranged from 0 to 9.1 out of 10 (median 3.9). Using a Food Frequency Questionnaire, 24/50 (48%) participants reported use of dietary supplements in the previous year. A third (18/50; 36%) had used self prescribed, non-iron containing dietary supplements, ingesting between 1 and 3 different supplements each day. Eight (16%) used fish oils. Despite having more severe epistaxis (p = 0.012), the 12 iron supplement users had higher serum iron concentrations, and were able to maintain their red blood cell indices. In contrast, there was no evident benefit for the participants using non iron supplements. Furthermore, platelet counts and serum fibrinogen tended to be lower in fish oil/supplement users, and one fish oil user demonstrated reduced in vitro platelet aggregation. In conclusion, in this small study, a third of HHT patients used non-iron dietary supplements, and one in six ingested fish oils, unaware of their known anti-platelet activity. The scale of use, and potential of these "natural health supplements" to exacerbate nosebleeds has not been appreciated previously in HHT.
authors.affiliation: National Heart and Lung Institute Cardiovascular Sciences, Imperial College London, UK; Imperial College School of Medicine, Imperial College London, UK.
authors.forename: Basel
authors.initials: B
authors.lastname: Chamali
authors.affiliation: National Heart and Lung Institute Cardiovascular Sciences, Imperial College London, UK; Diabetes and Nutritional Sciences Division, King's College London, UK.
authors.forename: Helen
authors.initials: H
authors.lastname: Finnamore
authors.affiliation: Haematology Department, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK.
authors.forename: Richard
authors.initials: R
authors.lastname: Manning
authors.affiliation: Haematology Department, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK; Centre for Haematology, Imperial College London, UK.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Laffan
authors.affiliation: Nutrition and Dietetics, Imperial College Healthcare NHS Trust, London, UK (Current address: School of Health Professions, Plymouth University, Plymouth, UK).
authors.forename: Mary
authors.initials: M
authors.lastname: Hickson
authors.affiliation: Diabetes and Nutritional Sciences Division, King's College London, UK.
authors.forename: Kevin
authors.initials: K
authors.lastname: Whelan
authors.affiliation: National Heart and Lung Institute Cardiovascular Sciences, Imperial College London, UK; HHTIC London, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK.
authors.forename: Claire L
authors.initials: CL
authors.lastname: Shovlin
keywords: Diet; Epistaxis; Iron; epistaxis severity score (ESS); fish oils