Final Diagnosis of Pediatric Patients with Prolonged in Activated Partial Thromboplastin Time Preoperative Study

Abstract

Introduction: Activated partial thromboplastin time (aPTT) is one of the most used coagulation tests in preoperative evaluation. Incidental detection of a prolonged aPTT is a problem in primary care, in which the general pediatrician should be able to attend its initial management. Objective: To describe final diagnosis of patients with prolonged aPTT in preoperative study. Materials and Methods: This is a descriptive study of patients referred from otorhinolaryngology. Results: Totally, 508 adenoidectomies and/or tonsillectomies were performed in our center, 38 of which referred patients (7.5%) with prolonged aPTT, and 30 of which met inclusion criteria. The median age was 4 years. 56.6% of patients were males. 76.6% of patients normalized aPTT at the second follow-up. Among these, 73.9% showed a normal study, 4.3% ha2d lupus anticoagulant and in 21.7% Von Willebrand disease was detected. Among patients that persisted with prolonged aPTT, 42.8% had coagulant factors deficiency, 28.5% had lupus anticoagulant and in 28.5% of patients a diagnosis could not be achieved with the tests used in the present study. Multivariate analysis did not show correlation between final diagnosis and the variables measured. Conclusion: The presence of a prolonged aPTT in children under preoperative study is due to a pre-analytic factor in the majority of cases or to the presence of lupus anticoagulant, normalizing values on follow-up. We suggest that a new aPTT be performed on these patients, and only those that persist altered or present a symptoms and family history of coagulation disorders be referred to hematology. N. Aguirre et al. 242

Standardisierte Gerinnungsanamnese vor Tonsillektomie und Adenotomie im Kindesalter

“…Aguirre et al analysierten darüber hinaus, welche Ursache hinter einer pathologischen PTT im pädiatrischen Kollektiv liegen. In ihrer Untersuchung waren 42,8 % der pathologisch veränderten PTT durch einen Gerinnungsfaktor-Mangel verursacht, bei 28,5 % waren Lupus-Antikoagulantien für die pathologische Veränderung verantwortlich und in einem genauso großen Anteil konnte keine Ursache gefunden werden [23]. Eine routinemäßige Diagnostik mittels PTT und PT war demnach in mehr als ein Viertel der pathologischen Fälle nicht zielführend, sodass diese Testparameter weiter an Bedeutung zu verlieren scheinen.…”

Prolongated Activated Partial Thromboplastin Time (aPTT) in Pediatric Patients before Surgery—Crying Wolf: Lupus (Anticoagulant) Does Not Always Threaten Children

“…Almost all of the above-mentioned works [ 9 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 ] underline some fundamental aspects, these being as follows: The relative low frequency of screening coagulation test abnormalities in the pediatric population investigated prior to surgery. A consistent incidence of LA/APAs among children with prolonged aPTT, and its significative relationship with recent infections (especially frequent upper air tract infections in children candidates for adenotonsillectomy).…”

“…Almost all of the above-mentioned works [9,[30][31][32][33][34][35][36][37][38] underline some fundamental aspects, these being as follows:…”