#PAGE_PARAMS# #ADS_HEAD_SCRIPTS# #MICRODATA#

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

1. Chee Y L, Crawford J C, Watson H G, Greaves M. Guidelines on the assessment of bleeding risk prior to surgery or invasive procedures. Brit J Haematol 2008; 140(5): 496-504.

2. Hörmann K. Joint statement on the need for preoperative coagulation tests before adenotomy and tonsillectomy in children. Laryngorhinootologie 2006; 85(8): 580-581.

3. American Academy of Otolaryngology – Head and Neck Sugery. Clinical indicators compendium. American Academy of Otolaryngology – Head and Neck Surgery Inc. Alexandria, VA. 1999.

4. Chrobok V, Pellant A, Janouch J, Komínek P, Kabelka Z, Šlapák I. Problematika předoperačního vyšetření před adenotomií a tonzilektomií u dětí. Otorinolaryng Foniat 2009; 58(4): 232-236.

5. Cabrnochová H. Předoperační vyšetření. Pohled praktického lékaře pro děti a dorost. Otorinolaryng Foniat 2009; 58(4): 254-255.

6. Černý V. Má být vyšetření hemokoagulace rutinní součástí předoperačního vyšetření před adenotomií a tonzilektomií u dětí? Otorinolaryng Foniat 2009; 58(4): 256.

7. http://www.cpsjep.cz/

8. Samková A, Pařízková E, Dulíček P. Význam předoperačního vyšetření hemostázy u dětí před adenotomií a tonzilektomií. Čes Slov Pediat 2009; 64(9): 400-405.

9. Schwaab M, Hansen S, Gurr A, Dazert S. Significance of blood tests prior to adenoidectomy. Laryngorhinootologie 2008; 87(2): 100-106.

10. Windfuhr JP, Chen YS. Post-tonsillectomy and -adenoidectomy hemorrhage in nonselected patients. Ann Otol Rhinol Laryngol 2003; 112(1): 63-70.

11. Garcia Callejo FJ, Pardo Mateu L, Velert Vila MM, Orts Alborch M, Monzó Gandía R, Marco Algarra J. Usefulness of preoperative coagulation tests in the prevention of post-tonsillectomy hemorrhage in children. Acta Otorrinolaringol Esp 1997; 48(6): 473-478.

12. Školoudík L, Dufek Z, Vokurka J, Čelakovský P. Krvácení po tonzilektomii. Otorinolaryng Foniat 2005; 54 (1): 42-46.

13. Arun B, Kessler CM. Clinical manifestations and Therapy of the Hemophilias. In: Hemostasis and Thrombosis. Basic principles and clinical practice. Colman RW, Hirsh J, Marder VJ, et al. Philadelphia, Lippincott Williams & Wilkins 2000; 815, 825.

14. Smejkal P, Matýsková M, Penka M. Von Willebrand disease. Vnitr Lek 2008; 54(3): 257-264.

15. Acharya SS, Coughlin A, Dimichele DM; North American Rare Bleeding Disorder Study Group. Rare Bleeding Disorder Registry: deficiencies of factors II, V, VII, X, XIII, fibrinogen and dysfibrinogenemias. J Thromb Haemost. 2004; 2(2): 248-256.

16. Andrew M, Vegh P, Johnston M, Bowker J, Ofosu F, Mitchell L. Maturation of the hemostatic system during childhood. Blood 1992; 80(8): 1998-2005.

17. Flanders MM, Crist RA, Roberts WL, Rodgers GM. Pediatric reference intervals for seven common coagulation assays. Clin Chem 2005; 51(9): 1738-1742.

18. Monagle P, Barnes C, Ignjatovic V, et al. Developmental haemostasis. Impact for clinical haemostasis laboratories. Thromb Haemost 2006; 95(2): 362-372.

19. http://www.hematology.cz/doporuceni-chs-meze.php

20. Jeyakumar A, Brickman TM, Williamson ME, et al. Nonsteroidal anti-inflammatory drugs and postoperative bleeding following adenotonsillectomy in pediatric patients. Arch Otolaryngol Head Neck Surg 2008; 134(1): 24-27.

21. Cardwell M, Siviter G, Smith A. Non-steroidal anti-inflammatory drugs and perioperative bleeding in paediatric tonsillectomy. Cochrane Database Syst Rev 2005; (2): CD003591.

22. Krishna S, Hughes LF, Lin SY. Postoperative hemorrhage with nonsteroidal anti-inflammatory drug use after tonsillectomy: a meta-analysis. Arch Otolaryngol Head Neck Surg 2003; 129(10): 1086-1089.

23. Koenig S, Gerstner T, Keller A, Teich M, Longin E, Dempfle CE. High incidence of valproate-induced coagulation disorders in children receiving valproic acid: a prospective study. Blood Coagul Fibrinolysis 2008; 19(5): 375-382.

24. Acharya S, Bussel JB. Hematologic toxicity of sodium valproate. J Pediatr Hematol Oncol 2000; 22(1): 62-65.

25. Gerstner T, Teich M, Bell N, et al. Valproate-associated coagulopathies are frequent and variable in children. Epilepsia 2006; 47(7): 1136-1143.

26. Licameli GR, Jones DT, Santosuosso J, Lapp C, Brugnara C, Kenna MA. Use of a preoperative bleeding questionnaire in pediatric patients who undergo adenotonsillectomy. Otolaryngol Head Neck Surg 2008; 139(4): 546-550.

27. Rodeghiero F, Castaman G, Tosetto A, et al. The discriminant power of bleeding history for the diagnosis of type 1 von Willebrand disease: an international, multicenter study. J Thromb Haemost 2005; 3(12): 2619-2626.

28. Kitszel A, Poznańska M, Krawczuk-Rybak M. Analysis of an abnormal coagulation profile in children qualified for adenoidectomy/tonsilectomy. Otolaryngol Pol 2007; 61(2): 158-161.

29. Shaw PH, Reynolds S, Gunawardena S, Krishnamurti L, Ritchey AK. The prevalence of bleeding disorders among healthy pediatric patients with abnormal preprocedural coagulation studies. J Pediatr Hematol Oncol 2008; 30(2): 135-141.

30. Shah MD, O’Riordan MA, Alexander SW. Evaluation of prolonged aPTT values in the pediatric population. Clin Pediatr (Phila) 2006; 45(4): 347-353.

Labels
Haematology Internal medicine Clinical oncology

Article was published in

Transfusion and Haematology Today

Issue 1

2011 Issue 1

Most read in this issue
Topics Journals
Login
Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.

Login

Don‘t have an account?  Create new account

#ADS_BOTTOM_SCRIPTS#