{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,5]],"date-time":"2026-02-05T08:28:00Z","timestamp":1770280080098,"version":"3.49.0"},"reference-count":66,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2016,4,23]],"date-time":"2016-04-23T00:00:00Z","timestamp":1461369600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Averil Macdonald Memorial Trust"},{"DOI":"10.13039\/501100000272","name":"National Institute for Health Research","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100000850","name":"National Heart and Lung Institute","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100000850","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["The Laryngoscope"],"published-print":{"date-parts":[[2016,11]]},"abstract":"<jats:sec><jats:title>Objectives\/Hypothesis<\/jats:title><jats:p>To examine whether there is a rationale for iron treatments precipitating nosebleeds (epistaxis) in a subgroup of patients with hereditary hemorrhagic telangiectasia (HHT).<\/jats:p><\/jats:sec><jats:sec><jats:title>Study Design<\/jats:title><jats:p>Survey evaluation of HHT patients, and a randomized control trial in healthy volunteers.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Nosebleed severity in response to iron treatments and standard investigations were evaluated by unbiased surveys in patients with HHT. Serial blood samples from a randomized controlled trial of 18 healthy volunteers were used to examine responses to a single iron tablet (ferrous sulfate, 200 mg).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Iron tablet users were more likely to have daily nosebleeds than non\u2013iron\u2010users as adults, but there was no difference in the proportions reporting childhood or trauma\u2010induced nosebleeds. Although iron and blood transfusions were commonly reported to improve nosebleeds, 35 of 732 (4.8%) iron tablet users, in addition to 17 of 261 (6.5%) iron infusion users, reported that their nosebleeds were exacerbated by the respective treatments. These rates were significantly higher than those reported for control investigations. Serum iron rose sharply in four of the volunteers ingesting ferrous sulfate (by 19.3\u201333.1 \u03bcmol\/L in 2 hours), but not in 12 dietary controls (2\u2010hour iron increment ranged from \u22122.2 to +5.0 \u03bcmol\/L). High iron absorbers demonstrated greater increments in serum ferritin at 48 hours, but transient rises in circulating endothelial cells, an accepted marker of endothelial damage.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Iron supplementation is essential to treat or prevent iron deficiency, particularly in patients with pathological hemorrhagic iron losses. However, in a small subgroup of individuals, rapid changes in serum iron may provoke endothelial changes and hemorrhage.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of Evidence<\/jats:title><jats:p>4.<jats:italic>Laryngoscope<\/jats:italic>, 126:2468\u20132474, 2016<\/jats:p><\/jats:sec>","DOI":"10.1002\/lary.25959","type":"journal-article","created":{"date-parts":[[2016,4,23]],"date-time":"2016-04-23T14:29:44Z","timestamp":1461421784000},"page":"2468-2474","source":"Crossref","is-referenced-by-count":20,"title":["Can Iron Treatments Aggravate Epistaxis in Some Patients With Hereditary Hemorrhagic Telangiectasia?"],"prefix":"10.1002","volume":"126","author":[{"given":"Claire L.","family":"Shovlin","sequence":"first","affiliation":[{"name":"Cardiovascular Sciences, National Heart and Lung Institute Imperial College London London United Kingdom"},{"name":"Respiratory Medicine Imperial College Healthcare National Health Service Trust London United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Clare","family":"Gilson","sequence":"additional","affiliation":[{"name":"Respiratory Medicine Imperial College Healthcare National Health Service Trust London United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark","family":"Busbridge","sequence":"additional","affiliation":[{"name":"Clinical Chemistry Imperial College Healthcare National Health Service Trust London United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dilip","family":"Patel","sequence":"additional","affiliation":[{"name":"Cardiovascular Sciences, National Heart and Lung Institute Imperial College London London United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chenyang","family":"Shi","sequence":"additional","affiliation":[{"name":"Cardiovascular Sciences, National Heart and Lung Institute Imperial College London London United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roberto","family":"Dina","sequence":"additional","affiliation":[{"name":"Department of Surgery and Cancer Imperial College London London United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"F. 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