epistaxis

A previously healthy 2-year-old boy presents with 3 days of recurrent nosebleeds. He had no adverse birth history and is up to date on his vaccinations. The patient’s mother denies any known trauma and the patient denies picking his nose. In addition, he has no fever, headaches, nausea, hematuria, dysuria, vision changes, or known toxic ingestions. The patient’s uncle previously had issues with bleeding after surgery. Physical exam is remarkable for ongoing epistaxis via bilateral nares. Initial laboratory results include white blood cell count 10,900/μL, hemoglobin 10.9 g/dL, platelet count 200 × 103/μL, APT 45.6s. What’s the diagnosis, and what are your next steps in evaluation and management?