7 year old in Emergency Room!!??

[vanesaS]

  my 7 year old son has two spider veins on his face. one on his
  : cheek and one on his chin. we were at an amusement park, and had
  : been there for several hours. it was extremely hot when my son
  : asked me what was on his chin. i was approx. 4 feet away from him
  : and realized i was being sprayed with blood. it sachurated his
  : shirt, my clothes from my shirt to my shoes was sprayed with blood
  : and as i extended my arm to cover they spray of blood it was
  : instanly covered with so much blood it was dripping! i realized
  : it was coming from the center of his spider vein. it had formed a
  : "head" on it almost like a pimple and continued to bleed for
  : several minutes. it was pulsing out with his heart beat. after
  : applying hard pressure it finally stopped and we applied a
  : bandaid and he seemed fine. we continued on with our day and within
  : 30 mins of walking around it started bleeding profussly again.
  : we applied a few minutes of pressure and decided to leave since
  : continuing in the heat seemed to be the cause. when we got home i
  : called our pediatrician and he says he never heard of a spider vein
  : bleeding like that and he recommended that even though it stopped
  : after getting out of the heat we take him to the ER. the doctor
  : there says she has seen it a lot and she put a refridgerant on it
  : and burned it. she says to keep him out of the heat and as calm
  : as is possible for an active child. she says it will continue to
  : do this until we go to a surgeon and have it "tied-off".
  : she also strongly recommended we have his liver enzymes tested as
  : soon as possible.
  : question 1....how serious is this profuse bleeding?
  : question 2....how common is this?
  : question 3....will it only do it in the day during extreme heat?
  : question 4....do we need to be concerned about it starting to
  : bleed during the middle of the night?
  : question 5...can he bleed to death if we didnt notice it(nights)?
  : question 6....what do the liver enzymes have to do with it?
  : question 7....what kind of liver disorders are related to facial
  : spider veins?
  : also, he is on no meds, has no drug allergies ( allergic to insect
  : bites and pertussis vaccine). and several people on both sides
  : of the family have spider veins ( though no have been know
  : to burst and bleed) and several people on both sides of the
  : family have liver diseases/disorders. he is 7 years old, weighs
  : 60 pounds and is 4'4''.
  : thank you for your time and any help in this matter.
  : vanessa

[HFHS.RN-AM]

Dear Vanessa,
First, lets address the liver question because it's a whole lot simpler.... liver's  play a big role in our blood's clotting mechanism. With liver disease, we are at greater risk of bleeding.. Liver enzymes are in indicator of the liver's functioning. Because he is only 7, I doubt his facial veins are related to his liver..you see these more in advanced liver disease, ie liver failure due to alcoholism or hepatitis. If he isn't complaining of appetite loss, weight loss, abdominal pain, abdominal distention or tenderness in the upper right quadrant, and if he isn't jaundiced (yellow skin tone, yellow sclera (whites of the eyes)), his liver is probably OK.
Now the hard question. What you describe as two small veins with a "pimple" area thats bleeding could be the tip of the iceburg of a larger vein-type malformation known as an arterio-venous malformation (A-V Malformation for short).   You need to see your sons pediatritian ASAP for a possible referral to a plastic surgeon for diagnosis. They may recommend a CT, angiogram, or MRI to further diagnose or determine course of treatment..  
Heat will dialate the bodies vascular system. Actually this is a safety mechanism to help us dissipate heat. Since these vessels are so superficial to the surface of the skin, they may look larger when your child is warm, but I cant imagine them spurting blood as you describe, unless it was irritated by something....could he have tried to pinch this "pimple"?.. Blood that spurts with each heart beat is arterial. It is pushed by a lot higher pressure than venous blood is, that is how these spurt when they bleed.. Veins drip when they bleed (the blood is a lot darker as well).
In the meantime, try to encourage your son not to irritate or pick at his scab....wash gently and pat to dry (dont scrub!), and teach him to apply pressure at the first sign of bleeding for 5-10 minutes. If the bleeding is profuse or doesnt stop, go to the ER immediately! And please seek a professional opinion without delay.
HFHS.RN-MD
*KEYWORD:   AV Malformation, Coagulopathy, Liver Failure, Hepatitis