Evaluation of Coagulation Disorders in Patients with Diseases of Waldeyer’s Ring

Hutchison, Robert; Davey, Frederick R.; Henry, John R.

doi:10.1016/s0030-6665(20)31650-9

Cited by 8 publications

(7 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Several hematologists recommend that the choice of the preoperative hemostatic screening test be based on data collected in the medical history and on the type of surgical procedure anticipated. 5,6 According to such rec ommendations, if the clinical history is negative or con tains no previous test of hemostasis, and the surgery is minor (e.g., uncomplicated dental extraction or excisional biopsy), screening laboratory tests are not rec ommended. If the clinical history is negative and con tains earlier tests of surgical hemostasis and the surgery is major (e.g., bowel resection or cholecystectomy), a platelet count and a PTT are recommended.…”

Section: Discussionmentioning

confidence: 99%

“…These four assays collectively screen for all in herited and acquired coagulation disorders. 6 The advantages of such an approach are numerous. Occult hemostatic defects can be more frequently iden tified and perioperative management changed accord ingly, thereby improving patient care.…”

Section: Discussionmentioning

confidence: 99%

“…1,3 • 24 We recommend that a comprehensive approach be taken when evaluating the hemostatic status of the can didate for adenotonsillectomy. In addition to conducting a thorough clinical history, which includes standardized questioning as suggested by Rappaport 5 or Hutchinson et al, 6 screening laboratory testing should include platelet count, PT and PTT tests, and a bleeding time test. These four assays collectively screen for all in herited and acquired coagulation disorders.…”

Section: Discussionmentioning

confidence: 99%

“…Evaluations were conducted by the same physician (W.E.B.). A hemostatic history was obtained on the basis of the questioning battery originally recommended by Rappaport 5 and later modified by Hutchinson et al 6 Laboratory evaluation included a platelet count, prothrombin time (FT), partial thromboplastin time (PTT), and Simplate bleeding time. Tonsillectomy or ade notonsillectomy or both were performed, predomi nantly via the electrocautery technique by the same otolaryngologist-in-training (W.E.B.…”

Section: Methodsmentioning

confidence: 99%

See 3 more Smart Citations

Preoperative Hemostatic Assessment of the Adenotonsillectomy Patient

Bolger

Parsons

Potempa

1990

Otolaryngol.--head neck surg.

View full text Add to dashboard Cite

Intraoperative or postoperative hemorrhage in the patient who has undergone an adenotonsillectomy because of an unrecognized hemostatic defect may increase morbidity and can be potentially life-threatening to the patient in what should be a "routine" procedure. Preoperative identification of occult hemostatic abnormalities, coupled with perioperative management directed at correcting the effects of the defects, should serve to reduce the incidence of this distressful complication. Routine use of preoperative laboratory screening tests for this purpose has been discouraged recently as a result of concerns over cost-effectiveness and the low predictiveness of the tests for bleeding. Our experience with the routine use of a comprehensive hemostatic laboratory screening panel--which includes a bleeding time test--in the adenotonsillectomy patient population demonstrated that 11.5% of our patients had abnormal initial screening laboratory tests; these results were ultimately attributable to occult hemostatic defects. Clinical history, the universally recommended method of preoperative hemostatic assessment, failed to detect any previously unrecognized coagulation disorder. Laboratory screening improved preoperative detection of occult hemostatic defects and allowed for appropriate alterations in perioperative care. Our results with this approach are presented, along with illustrative case histories and a discussion of the current recommendations for preoperative laboratory screening of the hemostatic system, as found in a review of the literature.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

See 2 more Smart Citations

Preoperative Hemostatic Assessment of the Adenotonsillectomy Patient

Bolger

Parsons

Potempa

1990

Otolaryngol.--head neck surg.

View full text Add to dashboard Cite

show abstract

“…Immediate or primary posttonsillectomy hemorrhage is defined as bleeding within the first 24 hours after the procedure 5 . It is usually attributed to the reopening of small vessels in the surgical wound 6 and is considered more serious than later bleeding because it occurs while the patient's responsiveness and protective airway reflexes are blunted by postanesthetic or narcotic effects 5 . Immediate bleeding is frequently more brisk and of a larger volume than delayed bleeding 5 …”

mentioning

confidence: 99%

Value of Preoperative Prothrombin Time/Partial Thromboplastin Time as a Predictor of Postoperative Hemorrhage in Pediatric Patients Undergoing Tonsillectomy

Howells

Wax

Ramadan

1997

Otolaryngol.--head neck surg.

View full text Add to dashboard Cite

OBJECTIVE: Hemorrhage after tonsillectomy is a potentially lethal complication. Preoperative assessment consisting of prothrombin time (PT) and activated partial thromboplastin time (PTT) has been used to identify patients at risk for hemorrhage after tonsillectomy and adenoidectomy. We sought to assess the value of PT/PTT screening as a predictor of posttonsillectomy hemorrhage. DESIGN: A retrospective chart review was carried out with a minimum of 1 month follow-up. SETTING: Tertiary academic referral center. PATIENTS: Between January 1992 and June 1995, 382 patients undergoing tonsillectomy were examined; 339 patients with a minimum of 1 month follow-up were reviewed for this study. MAIN OUTCOME MEASURE: Normal and prolonged PT/PTT values were examined. Bleeding in the intraoperative, immediate postoperative, and delayed phases of healing was examined. RESULTS: Two-hundred and twenty-two patients had normal PT/PTT, 39 had prolonged PT/PTT, and 78 had no preoperative studies performed. Bleeding occurred in 2.7%, 2.6%, and 3.3%, respectively, of patients. Eight patients had positive family histories of bleeding tendencies. One patient (12.5%) with a normal PT/PTT experienced a delayed posttonsillectomy bleed. Of 39 patients with abnormal coagulation studies, 30 were borderline elevations with no repeat studies done; one patient experienced postoperative hemorrhage. Nine abnormal results were repeated; three returned to normal, three remained prolonged but underwent tonsillectomy with no intervention, and three received hematology consultations. One patient had lupus anticoagulant, one had Hageman Factor deficiency, and one was cleared for surgery with no diagnosis. All patients underwent tonsillectomy with no episodes of postoperative bleeding. CONCLUSIONS: Preoperative PT/PTT provides no additional information than does a bleeding history for the general pediatric population undergoing tonsillectomy. This should only be done in selective cases where warranted by history.

show abstract

Gerinnungsuntersuchungen vor Tonsillektomie oder Adenotomie?

Deitmer

2001

HNO

View full text Add to dashboard Cite

Im Fokus | HNO 5•2001 344Kürzlich ist in den "Archives of Otolaryngology Head and Neck Surgery" eine Arbeit mit dem Titel "Preoperative coagulation studies prior to tonsillectomy" samt zwei Kommentaren zum selben Thema erschienen [6]. Die Autoren Hartnick u. Rubens beschäftigen sich mit der Frage, welche Laborunterschungen vor einer Tonsillektomie notwendig sind und ob sie überhaupt durchgeführt werden sollten.Wie schon in früheren Jahren durch mehrere andere Autoren [3,7,8,9] thematisch angegangen, gehen die Autoren Hartnick u. Ruben in diesem Artikel der Frage nach, ob und welche Laboruntersuchungen vor einer Tonsillektomie durchgeführt werden sollten. Ziel dieser Laboruntersuchungen soll es natürlich sein, Patienten zu identifizieren, die ein erhöhtes intraoperatives und v. a. auch postoperatives Blutungsrisiko haben, um die Indikation angesichts solcher Risikoerhöhungen erneut zu diskutieren oder besondere Maßnahmen bei der Operation oder in der Nachsorge zu treffen.Die Arbeit von Hartnick u. Ruben ist eine Übersicht, die Originalien über teils mehrere Tausend Tonsillektomien der Literatur kritisch wertet. Die Autoren stellen die Hypothese auf,dass die Bestimmung von Hämato-kritwert und Thrombozytenzahl als Voruntersuchung hinreichend sei, wenn sich aus Eigen-und Familienanamnese keine Auffälligkeiten ergäben.Argumente für eine nur sehr eingeschränkte präoperative Labordiagnostik sehen sie in den Kosten der gerinnungsphysiologischen Untersuchungen, der Seltenheit von Gerinnungsstörungen im Kindesalter und der Tatsache,dass die gerinnungsphysiologischen Globaltests nicht mit aller Sicherheit denkbare Gerinnungsstörungen wie Hämophilien und von-Willebrand-Syndrom erfassen,Tests teilweise bei Wiederholung normal sind und gelegentlich intrinsische Inhibitoren auffällige Testergebnisse verursachen.Retrospektive Analysen von Nachblutungsfällen zeigen oftmals auch nur in einem geringen Prozentsatz pathologische Werte in den präoperativen Labordaten, sodass die Erkenntnis gestützt wird, dass Nachblutungen nach Tonsillektomien Ursachen in der Operationstechnik, der lokalen Gefäßversorgung,dem postoperativen Blutdruck und evtl. postoperativen Entzündungsvorgängen haben können und eben nur ein geringer Anteil durch systemische Gerinnungsstörungen verursacht wird, die durch solche Laborwerte zuvor erkennbar wären. Hingegen wird auch eine Studie zitiert, in der retrospektiv analysiert eine deutlich höhere Nachblutungsrate in der Patientengruppe mit präoperativ abnormalen Gerinnungswerten bestand und so die Bedeutung von solchen Laboruntersuchungen betont wird. Auch ergaben sich erhebliche Anteile pathologischer Gerinnungswerte in einer Patientengruppe,die selbst bei genauer und gezielter Familien-und Eigenanamnese unauffällig war; so wird der Voraussage-und Selektionwert einer solchen strukturierten Befragung, der in anderen Studien sehr gelobt wird, doch wieder in Frage gestellt.Die Autoren betonen,dass statistische Überlegungen zur Voraussagewahrscheinlichkeit von Komplikationen einerseits und Kosten andererseits nicht ...

show abstract

Evaluation of Coagulation Disorders in Patients with Diseases of Waldeyer’s Ring

Cited by 8 publications

References 12 publications

Preoperative Hemostatic Assessment of the Adenotonsillectomy Patient

Preoperative Hemostatic Assessment of the Adenotonsillectomy Patient

Value of Preoperative Prothrombin Time/Partial Thromboplastin Time as a Predictor of Postoperative Hemorrhage in Pediatric Patients Undergoing Tonsillectomy

Gerinnungsuntersuchungen vor Tonsillektomie oder Adenotomie?

Contact Info

Product

Resources

About