45 y old female

PC severe nose bleed

HPC started 3 hours ago

initially tried to lie down

squeezing the nose with

handkerchief not successful had similar episode 3-4 times in the last 2 years

PMH Road traffic accident (RTA)

in 2007 with spinal injury

hypertension (not well controlled)

sickle cell anaemia

polycystic ovaries syndrome

occasional constipation

DH ramipril

HCT (hydrochlorothiacid)

nebivolol

iron substitution

SH lives with husband and 3 children

works in call centre

smokes 2-3 / day

social drinker but not excessively

FH uncle, aunt and

grandfather – sickle cell anaemia

daughter – Down’s syndrome