Occurrence of Coagulation Factor Deficiency in Post-tonsillectomy Hemorrhage

Overview

Journal Wien Klin Wochenschr

Publisher Springer

Specialty General Medicine

Date 2011 Apr 12

PMID 21479651

Citations 1

Authors

Michaela Zumtobel

Klemens Frei

Affiliations

Soon will be listed here.

Abstract

Introduction: Tonsillectomy is one of the most common surgical procedures in Otorhinolaryngology and approximately 500 tonsillectomies are performed annually at the University Hospital of Vienna. Substantial postoperative bleeding is observed in 1.8% of cases, which is comparable to frequencies of 2-4% reported in other studies. Currently, routine pre-surgical coagulation investigations to predict bleeding status do not include the analysis of individual coagulation factors.

Material And Methods: Within 2007 complete coagulation diagnostics were carried out in three patients presenting with recurrent (2-7 times) post-tonsillectomy hemorrhage but normal pre-surgical coagulation status parameters.

Results: After the appearance of recurrent late bleeding, single factor diagnostic analysis revealed the causes to be factor XIIa deficiency, reduced factor XIIIa or von Willebrand disease. Recurrent late bleeding was stopped by the application of coagulation active plasma.

Conclusion: This study shows that, even if routine diagnostics show normal pre-surgical coagulation findings, the investigation of single factors in cases of post-surgical late bleeding may identify coagulation disorders allowing the application of tailored therapy. Including such analysis in pre-operative diagnostics could therefore significantly help to limit postoperative bleeding.

Citing Articles

Recurrent Post Tonsillectomy Secondary Hemorrhage in Patients with Factor XIII Deficiency: A Case Series and Review of Literature.

Mohammed H, Abu Rajab Altamimi Z, Sheikh R, Al Taweel H, Ganesan S Am J Case Rep. 2016; 17:850-854.

PMID: 27843132 PMC: 5111571. DOI: 10.12659/ajcr.900391.

References

Howells 2nd R, Wax M, Ramadan H . Value of preoperative prothrombin time/partial thromboplastin time as a predictor of postoperative hemorrhage in pediatric patients undergoing tonsillectomy. Otolaryngol Head Neck Surg. 1998; 117(6):628-32. DOI: 10.1016/S0194-59989770044-5. View

Arnoldner C, Grasl M, Thurnher D, Hamzavi J, Kaider A, Brunner M . Surgical revision of hemorrhage in 8388 patients after cold-steel adenotonsillectomies. Wien Klin Wochenschr. 2008; 120(11-12):336-42. DOI: 10.1007/s00508-008-0982-9. View

Windfuhr J, Wienke A, Chen Y . Electrosurgery as a risk factor for secondary post-tonsillectomy hemorrhage. Eur Arch Otorhinolaryngol. 2008; 266(1):111-6. DOI: 10.1007/s00405-008-0720-y. View

Hormann K . [Joint statement on the need for preoperative coagulation tests before adenotomy and tonsillectomy in children]. Laryngorhinootologie. 2006; 85(8):580-1. DOI: 10.1055/s-2006-944590. View

Bolger W, PARSONS D, Potempa L . Preoperative hemostatic assessment of the adenotonsillectomy patient. Otolaryngol Head Neck Surg. 1990; 103(3):396-405. DOI: 10.1177/019459989010300310. View

Scheckenbach K, Bier H, Hoffmann T, Windfuhr J, Bas M, Laws H . [Risk of hemorrhage after adenoidectomy and tonsillectomy. Value of the preoperative determination of partial thromboplastin time, prothrombin time and platelet count]. HNO. 2007; 56(3):312-20. DOI: 10.1007/s00106-007-1585-x. View

Cohen D, Dor M . Morbidity and mortality of post-tonsillectomy bleeding: analysis of cases. J Laryngol Otol. 2007; 122(1):88-92. DOI: 10.1017/S0022215107006895. View

Cannizzaro E, Albisetti M, Wohlrab G, Schmugge M . Severe bleeding complications during antiepileptic treatment with valproic acid in children. Neuropediatrics. 2007; 38(1):42-5. DOI: 10.1055/s-2007-981448. View

Rodeghiero F, Tosetto A, Castaman G . How to estimate bleeding risk in mild bleeding disorders. J Thromb Haemost. 2007; 5 Suppl 1:157-66. DOI: 10.1111/j.1538-7836.2007.02520.x. View

10.

Close H, Kryzer T, Nowlin J, Alving B . Hemostatic assessment of patients before tonsillectomy: a prospective study. Otolaryngol Head Neck Surg. 1994; 111(6):733-8. DOI: 10.1177/019459989411100606. View

11.

Jeyakumar A, Brickman T, Williamson M, Hirose K, Krakovitz P, Whittemore K . Nonsteroidal anti-inflammatory drugs and postoperative bleeding following adenotonsillectomy in pediatric patients. Arch Otolaryngol Head Neck Surg. 2008; 134(1):24-7. DOI: 10.1001/archoto.2007.11. View

12.

Koscielny J, Ziemer S, Radtke H, Schmutzler M, Pruss A, Sinha P . A practical concept for preoperative identification of patients with impaired primary hemostasis. Clin Appl Thromb Hemost. 2004; 10(3):195-204. DOI: 10.1177/107602960401000301. View

13.

Borzotta A, Keeling M . Value of the preoperative history as an indicator of hemostatic disorders. Ann Surg. 1984; 200(5):648-52. PMC: 1250551. DOI: 10.1097/00000658-198411000-00016. View

14.

Windfuhr J, Schloendorff G, Baburi D, Kremer B . Lethal outcome of post-tonsillectomy hemorrhage. Eur Arch Otorhinolaryngol. 2008; 265(12):1527-34. DOI: 10.1007/s00405-008-0699-4. View

15.

Segal N, Puterman M, Rotem E, Niv A, Kaplan D, Kraus M . A prospective randomized double-blind trial of fibrin glue for reducing pain and bleeding after tonsillectomy. Int J Pediatr Otorhinolaryngol. 2008; 72(4):469-73. DOI: 10.1016/j.ijporl.2007.12.011. View

16.

Manning S, Beste D, McBride T, GOLDBERG A . An assessment of preoperative coagulation screening for tonsillectomy and adenoidectomy. Int J Pediatr Otorhinolaryngol. 1987; 13(3):237-44. DOI: 10.1016/0165-5876(87)90104-2. View

17.

Dhiwakar M, Clement W, Supriya M, McKerrow W . Antibiotics to reduce post-tonsillectomy morbidity. Cochrane Database Syst Rev. 2008; (2):CD005607. DOI: 10.1002/14651858.CD005607.pub2. View

18.

Pfanner G, Koscielny J, Pernerstorfer T, Gutl M, Perger P, Fries D . [Preoperative evaluation of the bleeding history. Recommendations of the working group on perioperative coagulation of the Austrian Society for Anaesthesia, Resuscitation and Intensive Care]. Anaesthesist. 2007; 56(6):604-11. DOI: 10.1007/s00101-007-1182-0. View

19.

Deitmer T . [Blood coagulation tests before tonsillectomy or adenoidectomy?]. HNO. 2001; 49(5):344-6. DOI: 10.1007/s001060050760. View

20.

Walker P, Gillies D . Post-tonsillectomy hemorrhage rates: are they technique-dependent?. Otolaryngol Head Neck Surg. 2007; 136(4 Suppl):S27-31. DOI: 10.1016/j.otohns.2006.10.022. View