Significance and causes of abnormal preoperative coagulation test results in children

Abstract

To prevent bleeding related to adenoidectomy and tonsillectomy, coagulation screening tests were, until recently, performed routinely in the Czech Republic for all paediatric patients. The aim of this study was to evaluate benefit of preoperative coagulation screening tests in children. We retrospectively analysed laboratory and clinical data of children referred for abnormal preoperative coagulation test results (aPTT, PT) to the outpatient haematology clinic. A total of 274 paediatric patients were retrospectively evaluated due to abnormal preoperative coagulation tests results. In 140 of 274 patients (51.1%), coagulation tests were normal on repeated testing in a specialized haematology clinic. Ten patients had decreased factor XII. Five patients had a suspected bleeding disorder which was confirmed in two of them. One patient had low levels of von Willebrand factor, and one patient had mild factor VII deficiency. Both these patients had positive personal and/or family history of bleeding. Each case history was taken individually, without use of standardized questionnaires. Bleeding complications were not observed, and coagulation factor replacement was not needed perioperatively in our cohort. The majority of abnormal findings in aPTT and PT appeared only transiently. All the bleeding disorders found in our cohort of patients were mild in nature. Our findings provide supportive evidence for the current national Czech recommendation: laboratory coagulation screening should be performed only in patients with positive family and/or personal bleeding history.

Bleeding Risk in Children with Preoperative Prolonged Coagulation Tests

“…Our study is different from other studies as it consisted of cases that were operated on despite the prolonged coagulation test results (7,17,21,22,23). A study reported that PT and/or aPTT were prolonged and surgical intervention was performed only with pro-coagulants and/or antifibrinolytics in mild factor deficiencies, and none required specific treatment due to bleeding complications (24). Since no specific factor deficiency was detected in our study, procoagulant or antifibrinolytic treatments were planned to be given in case of bleeding.…”

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).…”

Preoperative evaluation in pediatric anesthesia

“…Avaliação pré-operatória em anestesia pediátrica que isso, o prolongamento do TTPa falso-positivo é comumente associado a anticorpos antifosfolipídios, comumente presentes em criança com infecções de vias aéreas ou após vacinação. 14,15 O exame de ECG pré-operatório de rotina não é recomendado em crianças saudáveis. Deve ser solicitado associado ao ecocardiograma em casos de sopro cardíaco patológico, suspeita de doença cardíaca congênita, apneia obstrutiva do sono, escoliose intensa, broncodisplasia pulmonar, doença neuromuscular em neonatos e crianças com menos de seis meses de vida, o qual pode detectar anormalidades de condução, como síndrome do QT longo e síndrome de Wolff-Parkinson-White.…”