Precautions to take:
All patients should be aware of the following recommendations:
- An intravenous air filter (IV filter) (bubble trap) should be used when a patient has an intravenous line. This is to prevent any large air bubbles from entering the bloodstream, going through a lung AVM, and then causing a temporary stroke. This is most effectively done by using a filter in the IV line as close to the patient as possible. A 0.22 micron filter is best, if available, but a blood filter is also acceptable (about 260 microns) and will stop all large air bubbles. During a blood transfusion however, a standard blood filter is all that is needed. Please note that filters often cannot be used for IV contrast injections which you might get for CT or MRI scans.
- Regular screening of cerebral AVMs is recommended as untreated cerebral AVMs are a common cause of haemorrhagic stroke in HHT families.
- Diagnosis and treatment for HHT has changed significantly in the last decade. HHT Ireland recommends that people who have one parent with HHT be assessed at a HHT Specialist Centre.
What I need to know about medications
For dental and other “dirty” procedures, such as tattooing, antibiotic prophylaxis are strongly recommended for all HHT patients with PAVMs (and those not yet screened) in order to prevent bacteria from entering the bloodstream which can lead to a brain abscess.
Certain medications containing blood thinning properties are best avoided if at all possible. These medications can thin the blood to a point where it can become difficult for HHT patients to stem their blood loss. Patients are advised to avoid NSAIDs – (Non-Steroidal Anti-Inflammatory Drugs) because of this.
Non-Steroidal Anti-Inflammatory Drugs (NSAIDS) such as aspirin, ibuprofen (Motrin, Advil), celecoxib (Celebrex) and others are not recommended for HHT patients. NSAIDS is a class of drugs that reduces pain, reduces fever, prevents blood clots and reduces inflammation. Increased bleeding may occur in HHT patients with these medications.
However, there are circumstances when HHT patients need to take NSAIDS but this should be under the guidance of your doctor.
Paracetamol (also called Acetaminophen) is recommended for HHT patients to treat minor aches, pains and reduce fever.
Calculate the severity of your nosebleeds online
Epistaxis Severity Scoring Tool (ESS): This is a way to monitor the severity of patients’ nosebleeds and their responses to treatment. This is a simple score that is calculated automatically when the patient answers 6 simple questions about their nosebleeds.
Online ESS Tool.
What I need to know about blood thinners
There are occasions where HHT patients need to be taking blood thinners. However, in the case of bleeding disorders, you need to know which substances should be avoided.
Foods with natural blood thinning properties
HHT Ireland suggests that you become aware of the natural blood-thinning foods in your diet. It is advisable to avoid the use of these foods if you are already on prescribed blood thinners! Too much blood thinning can cause bleeding in other areas of your body including the brain.
- Herbs and spices – Many herbs & spices contain salicylates (a natural blood thinner) including cayenne pepper, cinnamon, curry powder, dill, ginger, licorice, oregano, paprika, peppermint, thyme and turmeric.
- Fruits which contain blood-thinning properties include blueberries, cherries, cranberries, grapes, oranges, prunes, raisins, strawberries and tangerines.
- Fish that can aid in anti-clotting include albacore tuna, anchovies, herring, lake trout, mackerel, and salmon. The main reason for this is high levels of omega-3 fatty acids.
- Other foods including olive oil, garlic and onions can affect the thinning of the blood.
Download Salicylate-List – a list of foods containing blood thinning properties (aka salicylates).
Significance of blood thinners
It is important to be aware of natural blood thinners. Blood thinners are required in conditions where blood clots easily, leading to serious complications. However, it is important to know which blood thinners to avoid if you have HHT – even in very low doses.
In many common bleeding conditions ( Nosebleeds, Haemorrhages, Menorrhagia (excess bleeding during menstruation in women) ) – bleeding may not stop and possibly prove fatal if uncontrolled blood thinning substances have been digested.
The health benefits of geranium essential oil
The Essential Oil of Geranium has a lot to offer HHT patients. Geranium Oil can stop bleeding in two ways: it causes blood vessels to contract and helps stop blood flow and it speeds up clotting of blood.
Topical Sesame/Rose geranium oil compound is an effective therapy for HHT associated (nosebleeds) epistaxis. A sesame/rose geranium oil compound can significantly reduce the epistaxis severity scores of patients with hereditary haemorrhagic telangiectasia-related epistaxis.
For professional advice consult your medical healthcare provider.