Imperial College London

Professor Claire Shovlin

Faculty of MedicineNational Heart & Lung Institute

Professor of Practice (Clinical and Molecular Medicine)



c.shovlin Website




534Block L Hammersmith HospitalHammersmith Campus






BibTex format

author = {Shovlin, CL and Gilson, C and Busbridge, M and Patel, D and Shi, C and Dina, R and Abdulla, FN and Awan, I},
doi = {10.1002/lary.25959},
journal = {The Laryngoscope},
pages = {2468--2474},
title = {Can iron treatments aggravate epistaxis in some patients with hereditary hemorrhagic telangiectasia?},
url = {},
volume = {126},
year = {2016}

RIS format (EndNote, RefMan)

AB - Objectives/HypothesisTo examine whether there is a rationale for iron treatments precipitating nosebleeds (epistaxis) in a subgroup of patients with hereditary hemorrhagic telangiectasia (HHT).Study DesignSurvey evaluation of HHT patients, and a randomized control trial in healthy volunteers.MethodsNosebleed 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).ResultsIron tablet users were more likely to have daily nosebleeds than non–iron-users as adults, but there was no difference in the proportions reporting childhood or trauma-induced 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 19.3–33.1 μmol/L in 2 hours), but not in 12 dietary controls (2-hour iron increment ranged from −2.2 to +5.0 μmol/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.ConclusionsIron 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.
AU - Shovlin,CL
AU - Gilson,C
AU - Busbridge,M
AU - Patel,D
AU - Shi,C
AU - Dina,R
AU - Abdulla,FN
AU - Awan,I
DO - 10.1002/lary.25959
EP - 2474
PY - 2016///
SN - 1091-756X
SP - 2468
TI - Can iron treatments aggravate epistaxis in some patients with hereditary hemorrhagic telangiectasia?
T2 - The Laryngoscope
UR -
UR -
VL - 126
ER -