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The Relevance of Routine Haemostasis Testing in Children Prior to Adenoidectomy and/or Tonsillectomy


Authors: A. Samková 1;  E. Pařízková 1;  P. Ďulíček 2
Authors‘ workplace: Dětská klinika LF UK a FN, Hradec Králové přednosta prof. MUDr. M. Bayer, CSc. 1;  I. interní klinika – oddělení klinické hematologie LF UK a FN, Hradec Králové přednosta prof. MUDr. J. Malý, CSc. 2
Published in: Čes-slov Pediat 2009; 64 (9): 400-405.
Category: Review

Overview

Adenoidectomy and tonsillectomy are two of the most frequent surgeries in children. In the most of Czech hospitals, screening tests to reveal possible impaired haemostasis and thus bleeding complications are routinely performed before such a surgery.

The benefit of this screening has been however questioned in many studies worldwide. It has been demonstrated that the screening has very low ability to predict the bleeding complications. The reason for those findings is the fact, that most bleeding complications result from local and/or surgical conditions, rather than inherited coagulation disorders. The likelihood to identify a new patient with haemostatic disorder is influenced by the prevalence of clinically significant disorders, which is very low. Moreover, high incidence of falsely positive findings mainly in aPTT in asymptomatic population is causing significant delays in planning of those elective surgical procedures because it often leads to further detailed testing of haemostasis to rule out clinically significant bleeding disorder.

We believe that thorough and careful personal and family history of bleeding tendency/disorder taken with the help of standardized questionnaire is more suitable tool for screening. The indication for laboratory haemostasis testing should be positive personal or family history of a bleeding tendency and/or an absence of a valid history at all.

Key words:
adenoidectomy, tonsillectomy, preoperative haemostasis testing, coagulation, bleeding


Sources

1. Chee YL, Crawford JC, Watson HG, et al. Guidelines on the assessment of bleeding risk prior to surgery or invasive procedures. British Journal of 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 Aug;85(8): 580–581.

3. American Academy of Otolaryngology – Head and Neck Sugery. Clinical Indicators Compendium. Alexandria, VA: American Academy of Otolaryngology – Head and Neck Surgery Inc., 1999.

4. Schwaab M, Hansen S, Gurr A, et al. Significance of blood tests prior to adenoidectomy. Laryngorhinootologie 2008 Feb;87(2): 100–106.

5. Windfuhr JP, Chen YS. Hemorrhage following pediatric tonsillectomy before puberty. Int. J. Pediatr. Otorhinolaryngol. 2001 May 11;58(3): 197–204.

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

7. Garcia Callejo FJ, Pardo Mateu L, Velert Vila MM, et al. Usefulness of preoperative coagulation tests in the prevention of post-tonsillectomy hemorrhage in children. Acta Otorrinolaringol. Esp. 1997;48(6): 473–478.

8. Školoudík L, Dufek Z, Vokurka J, et al. Krvácení po tonzilektomii. Otorinolaryng. a Foniat. 2005;54 (1): 42–46.

9. Scheenstra RJ, Hilgevoord AA, Van Rijn PM. Serious haemorrhage after conventional (adeno)tonsillectomy: rare and most often on the day of the procedure. Ned. Tijdschr. Geneeskd. 2007 Mar 10;151(10): 598–601.

10. Myssiorek D, Alvi A. Post-tonsillectomy hemorrhage: an assessment of risk factors. Int. J. Pediatr. Otorhinolaryngol. 1996 Sep;37(1): 35–43.

11. Windfuhr JP, Schloendorff G, Baburi D, et al. Lethal outcome of post-tonsillectomy hemorrhage. Eur. Arch. Otorhinolaryngol. 2008 Dec;265(12): 1527–1534.

12. Swoboda H, Welleschik B. A severe late tonsillar hemorrhage 2 months postoperatively. Laryngol. Rhinol. Otol. (Stuttg). 1988 Aug;67(8): 431–433.

13. Howells RC 2nd, Wax MK, Ramadan HH. Value of preoperative prothrombin time/partial thromboplastin time as a predictor of postoperative hemorrhage in pediatric patients undergoing tonsillectomy. Otolaryngol. Head Neck. Surg. 1997 Dec;117(6): 628–632.

14. Prim MP, De Diego JI, Jimenez-Yuste V, et al. Analysis of the cause of immediate unanticipated bleeding after pediatric adenotonsillectomy. Int. J. Pediatr. Otorhinolaryngol. 2003;67(4): 341–344.

15. Gabriel P, Mazoit X, Ecoffey C. Relationship between clinical history, coagulation tests, and perioperative bleeding during tonsillectomies in pediatrics. J. Clin. Anesth. 2000;12(4): 288–291.

16. Scheckenbach K, Bier H, Hoffmann TK, et al. Risk of hemorrhage after adenoidectomy and tonsillectomy. Value of the preoperative determination of partial thromboplastin time, prothrombin time and platelet count. HNO 2008 Mar;56(3): 312–320.

17. Asaf T, Reuveni H, Yermiahu T, et al. The need for routine pre-operative coagulation screening tests (prothrombin time PT /partial thromboplastin time PTT) for healthy children undergoing elective tonsillectomy and/or adenoidectomy. Int. J. Pediatr. Otorhinolaryngol. 2001;61: 217–222.

18. Close HL, Kryzer TC, Nowlin JH, et al. Hemostatic assesment of patients before tonsillectomy: a prospective study. Otolaryngol. Head Neck. Surg. 1994;111(6): 733–738.

19. Eberl W, Wendt I, Schroeder HG. Preoperative coagulation screening prior to adenoidectmy and tonsillectomy. Klin. Padiatr. 2005;217(1): 20–24.

20. Eisert S, Hovermann M, Bier H, et al. Preoperative screening for coagulation disorders in children undergoing adenoidectomy (AT) and tonsillectomy (TE): Does it prevent bleeding complications? Klin. Padiatr. 2006;218: 334–339.

21. Zwack GC, Derkay CS. The utility of preoperative hemostatic assesment in adenotonsillectomy. Int. J. Pediatr. Otorhinolaryngol. 1997; 9(1): 67–76.

22. Kang J, Brodsky L, Danziger I, et al. Coagulation profile as a predictor for post-tonsillectomy and adenoidectomy (T + A) hemorrhage. Int. J. Otorhinolaryngol. 1994;28(2–3): 157–165.

23. 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.

24. Shaw PH, Reynolds S, Gunawardena S, et al. The prevalence of bleeding disorders among healthy pediatric patients with abnormal preprocedural coagulation studies. J. Pediatr. Hematol. Oncol. 2008 Feb;30(2): 135–141.

25. Licameli GR, Jones DT, Santosuosso J, et al. Use of a preoperative bleeding questionnaire in pediatric patients who undergo adenotonsillectomy. Otolaryngol. Head Neck. Surg. 2008 Oct;139(4): 546–550.

26. Arun B, Kessler CM. Clinical manifestations and therapy of the hemophilias. In: Colman RW, Hirsh J, Marder VJ, et al. Hemostasis and Thrombosis. Basic Principles and Clinical Practice. Philadelphia: Lippincott Williams & Wilkins, 2000: 815, 825.

27. Registr Hemis: http://www.hemis.cz/index.php?id=8&cil=2

28. Smejkal P, Matýsková M, Penka M. Von Willebrand disease. Vnitř. Lék. 2008 Mar;54(3): 257–264.

29. Sadler JE, Rodeghiero F. Provisional criteria for the diagnosis of VWD type 1: on behalf of the ISTH SSC Subcommittee on Von Willebrand Factor. Journal of Thrombosis and Haemostasis 2005 Apr;3,4: 775–777.

30. Ragni MV, Bontempo FA, Hassett AC. Von Willebrand disease and bleeding in women. Haemophilia 1999 Sep;5(5): 313–317.

31. Ziv O, Ragni MV. Bleeding manifestations in males with von Willebrand disease. Haemophilia 2004 Mar;10(2): 162–168.

32. 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 Feb;2(2): 248–256.

33. Giansily-Blaizot M, Schved JF. Potential predictors of bleeding risk in inherited factor VII deficiency. Clinical, biological and molecular criteria. Thromb. Haemost. 2005 Nov;94(5): 901–906.

34. Starý J, Smíšek P, Spoustová L, et al. Imunní (idiopatická) trombocytopenická purpura – incidence, diagnostické a léčebné přístupy v České republice. Čes.-slov. Pediat. 2001;56(3): 111–115.

35. Johnson RK, Mortimer AJ. Routine pre-operative blood testing: is it necessary? Anaesthesia 2002;57: 914–917.

36. Mallick MS. Is routine pre-operative blood testing in children necessary? Saudi Med. J. 2006 Dec;27(12): 1831–1834.

37. Munro J, Booth A, Nicholl J. Routine preoperative testing: a systematic review of the evidence. Health Technol. Assess. 1997;1(12): i–iv; 1–62.

38. Krishna P, Lee D. Post-tonsillectomy bleeding: a meta-analysis. Laryngoscope 2001;111(8): 1358–1361.

Labels
Neonatology Paediatrics General practitioner for children and adolescents
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