Preoperative Screening for Coagulation Disorders in Children Undergoing Adenoidectomy (AT) and Tonsillectomy (TE): Does it Prevent Bleeding Complications?

Abstract

In our study, coagulation screening failed to effectively identify patients at risk of bleeding.

Coagulation tests or Standardized questionnaire, which is better as a predictor of bleeding? A prospective study among children before tonsillectomy and/or adenoidectomy.

“…The rate of bleeders in patients with normal coagulation tests was 11.6%, while in the group with abnormal blood tests was 19.2%, these higher rates in the bleeding group were not statistically significant, but can still give a feeling that coagulation tests though not sensitive in predicting bleeding, may have additional value and should not be initially invalidated. We agree with the opinion of many researchers that it may not be necessary to perform these tests in every child prior to T/AD [4][5][6]9,10], however, we recommend these tests in any child with a positive medical history or questionnaire. When both the questionnaire and the coagulation tests are positive, pediatric hematologist consultation should be considered.…”

“…Both the British Committee for standards in Hematology 2008 and the American Academy of Otolaryngology-Head and Neck surgery did not recommend standard pre-operative coagulation tests [1,9]. Recommendations against performing standardized coagulation laboratory test are supported by a large body of literature [4][5][6]9,10].…”

Do diet and activity restrictions influence recovery after adenoidectomy and partial tonsillectomy?

“…Excessive physical exertion elevates blood pressure and can result in subsequent bleeding from the wound in the throat, as it was noted in several participants of the present study immediately after the effort. Logically, frequency of hemorrhages after pediatric adenotonsillectomy should not significantly differ from observed after adenoidectomy/adenotonsillotomy [14,15] but this proportion has not been investigated. Partial removal of palatine tonsils has become a standard and effective procedure in children with obstructive symptoms due to tonsillar hypertrophy [16][17][18].…”

Is the activated partial thromboplastin time suitable to screen for von Willebrand factor deficiencies?

“…Routine complementary testing for asymptomatic patients before surgery yields an unexpectedly high percentage of anomalous results, which rarely affect perioperative management but may lead to unnecessary delays, especially in emergency surgery. Although it has been highlighted that preoperative aPTT provides no additional information than does a bleeding history for the general paediatric population undergoing surgery [13,14], some patients with bleeding disorders may still be identified during routine preoperative coagulation testing and replacement therapy or delay/cancellation of surgery may reduce or prevent perioperative haemorrhage [15].…”