Samková A., Dulíček P., Pařízková E., Vokurka J.: Is coagulation screening before adenoidectomy and tonsillectomy really necessary?
Authors:
A. Samková 1; P. Ďulíček 2; E. Pařízková 1; J. Vokurka 3
Authors‘ workplace:
Dětská klinika, 2I. interní klinika – oddělení klinické hematologie, 3Klinika ušní, nosní a krční, Lékařská fakulta Univerzity Karlovy v Hradci Králové a Fakultní nemocnice v Hradci Králové
1
Published in:
Transfuze Hematol. dnes,17, 2011, No. 1, p. 25-29.
Category:
Comprehensive Reports, Original Papers, Case Reports
Overview
Introduction:
In the most of hospitals in the Czech Republic is the routine laboratory screening of haemostasis performed before adenoidectomy and tonsillectomy. However, the benefit of this testing has been questioned, due to the very low predictive value and low prevalence of clinically relevant bleeding disorders. The aim of our study is to identify the most frequent causes of prolongation of aPTT and PT (INR), to outline the haemostatic background in these patients and to suggest suitable history questionnaire for revealing haemostasis disorders.
Patients and methods:
106 paediatric patients before adenoidectomy or/ and tonsillectomy were prospectively examined. A part of the preoperative screening was a questionnaire focused on bleeding diathesis of the child and the family. Laboratory testing consisted of whole blood count, blood group, bleeding time (Duke), PT (INR), aPTT, aPTT with a higher sensitivity to lupus anticoagulans, dRVVT, and D-dimers. In case of prolongation of PT or aPTT further testing was done for identifying the cause.
Results:
Mild bleeding symptoms were found in the history of 2 children. No bleeding disorders were found in the patientęs families, however mild bleeding symptoms were found in the history of close relatives of 4 children. 36 children had prolonged aPTT according to age the unspecified reference range. When compared with reference range according to age, aPTT was prolonged in 6 children, while PT was prolonged in only 2. Unspecific inhibitor was found as the cause of prolonged aPTT in 2 patients. No bleeding disorder was detected in the rest of the patients. Any serious bleeding occurred peri- or postoperative among the children.
Conclusion:
Prolongation of coagulation tests is a common finding in routine pre-operative testing for adenoidectomy and tonsillectomy and is most frequently caused by clinically non-relevant reasons, especially unspecific inhibitor. It is necessary to compare the values of coagulation tests with the age specific reference range.
Key words:
adenoidectomy, tonsillectomy, preoperative coagulation testing, bleeding history, bleeding, children
Sources
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