- Check clotting and platelets.
- Adjust anticoagulants, consider platelet transfusion if low platelets due to chemotherapy, discuss if necessary with haematologist.
- Encourage dark towels/handerchiefs/underwear/use of green or blue toilet disinfectant block to disguise blood loss (according to site) if frightened.
- Remember although major haemorrhage is very rare; fear is very common (with professionals and patients).
- If major haemorrhage is a risk, assess benefit/risk of preparing patient and/or family and consider making crisis medication easily available (single syringes of diamorphine and midazolam).
- If major haemorrhage is a risk, talk through the care plan with the team. Is further information needed from the diagnostic team? Is basic equipment - dark towels/cloths, gloves, buckets, etc. easily available? Does a family member need to be involved with care planning? Who will administer crisis medication? Is there a plan to diall 999 or to contain the situation at home?
- Alginate dressings changing as little as possible.
- Topical Sucralfate paste (crush 1g in 10g water-miscible gel) or 1% alum solution Topical Tranexamic acid (soaked onto dressings,or as an enema for rectal bleeding, or as a mouthwash/gargle for oral bleeding).
- Consider radiotherapy, laser treatment, diathermy.
- Intraluminal treatment may be possible.
- Ethamsylate 500mg qds
- Tranexamic acid 1g tds
© Dr. Eileen Palmer, Dr John Howarth Palliative Care for the Primary Health Care Team (2004) Quay Books ISBN 1856422291