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[Analysis of an abnormal coagulation profile in children qualified for adenoidectomy/tonsilectomy]
Anna Kitszel1, Marta Poznańska, Maryna Krawczuk-Rybak
1Klinika Onkologii Dzieciecej AM, Samodzielny Publiczny Dzieciecy Szpital Kliniczny w Białymstoku.
Insights
Routine coagulation screening for children undergoing tonsillectomy is often unnecessary. Many identified coagulation defects are transient or minor, with a small percentage posing significant bleeding risks.
Area of Science:
- Pediatric Surgery
- Hematology
- Clinical Coagulation
Context:
- Pre-operative evaluation for tonsillectomy often includes coagulation screening.
- Identifying coagulation defects is crucial for surgical safety in children.
Purpose:
- To evaluate the prevalence and significance of coagulation disorders in children undergoing elective tonsillectomy and/or adenoidectomy.
Summary:
- 68 children with abnormal coagulation profiles were tested. 22% showed prolonged APTT and/or PT, with isolated prolonged APTT being most common.
- Vitamin K normalized tests in 36%. Factor XII deficiency was most frequent, alongside rare von Willebrand and Factor VIII/IX deficiencies.
- Most children with prolonged APTT without identified factor deficiencies underwent surgery without complications, but 4% with undiagnosed defects may face bleeding risks.
Impact:
- Findings suggest that many pre-operative coagulation abnormalities in this pediatric group are not clinically significant.
- This research may inform guidelines on routine coagulation screening prior to tonsillectomy, potentially reducing unnecessary testing.
- Highlights the importance of careful assessment, as a small subset of undiagnosed coagulation disorders can lead to severe post-operative bleeding.
Introduction:
The routine pre-operative evaluation of children undergoing elective tonsillectomy and/or adenoidectomy includes coagulation screening tests.
The Purpose Of The Study:
detection of coagulation defects in children with planned tonsillectomy and/or adenoidectomy.
Material And Methods:
In our study we examined 68 children with abnormal coagulation profile, age 1-17 (average 7.5), 43 male and 25 female. All children underwent coagulation tests (APTT, PT, INR, D-dimer, fibrynogen). In case of twice indicated coagulopathy we diagnosed the levels of the coagulation protein factors.
Results:
After second verification 15/68 (22%) patients presented prolonged APTT and/or PT. The most common disorder was isolated prolongation of APTT--47/53 (89%), 3/53 (5.5%) had prolonged PT and 3/53 (5.5%) had both disorders in the same time. After vitamin K admission in 19/53 (36%) coagulation tests returned to normal. 13/53 (24%) patients had the factor XII deficiency, 1 patient had a low activity of von Willebrand factor and temporary deficient of factor VIII. In one case we found temporary deficiency of factors VIII and IX and one boy had isolated, temporary deficiency of factor IX. Rest of patients 21/53 (40%), in which the activity of coagulation factors were normal, underwent surgery despite prolonged APTT without any bleeding during or after surgery.
Conclusions:
The coagulation disorders in analized group of children were unstable or inessential, but in a group of 3/68 (4%) nondiagnosed disorders of coagulation tests, may due to heavy bleeding during or after surgery.
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