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Significance and causes of abnormal preoperative coagulation test results in children

A Samková1, J Blatný, V Fiamoli

  • 1Department of Pediatrics, University Hospital, Charles University, Hradec Kralove, Czech Republic. anetasamkova@atlas.cz

Haemophilia : the Official Journal of the World Federation of Hemophilia
|October 5, 2011
PubMed

Insights

Routine preoperative coagulation screening for children undergoing adenoidectomy and tonsillectomy is not beneficial. Most abnormal results were transient, and significant bleeding disorders are rare in children without a bleeding history.

Area of Science:

  • Pediatric Hematology
  • Surgical Hemostasis
  • Clinical Pathology

Background:

  • Historically, routine preoperative coagulation screening tests (activated partial thromboplastin time [aPTT], prothrombin time [PT]) were standard for pediatric patients undergoing adenoidectomy and tonsillectomy in the Czech Republic to prevent bleeding.
  • Recent evidence suggests that routine screening may not be cost-effective or clinically beneficial for all pediatric surgical patients.

Purpose of the Study:

  • To evaluate the clinical utility and yield of preoperative coagulation screening tests in pediatric patients undergoing adenoidectomy and tonsillectomy.
  • To determine the incidence of true bleeding disorders among children with initially abnormal coagulation test results.

Main Methods:

  • Retrospective analysis of laboratory and clinical data from 274 pediatric patients referred to an outpatient hematology clinic for abnormal preoperative coagulation tests (aPTT, PT).
  • Re-evaluation of coagulation parameters and review of personal/family bleeding history for each patient.
  • Assessment for perioperative bleeding complications.

Main Results:

  • Over half (51.1%) of the initial abnormal coagulation tests (aPTT, PT) were normal upon repeat testing in a specialized clinic.
  • Only two patients (0.7%) were confirmed to have mild bleeding disorders (von Willebrand factor deficiency and factor VII deficiency), both with a positive bleeding history.
  • Ten patients had decreased factor XII, and no bleeding complications were observed in the cohort; factor replacement was not required.

Conclusions:

  • Routine preoperative coagulation screening in pediatric patients undergoing adenoidectomy and tonsillectomy is not recommended.
  • Screening should be reserved for patients with a documented personal or family history of bleeding.
  • The majority of initially abnormal coagulation tests in this pediatric cohort were transient or clinically insignificant.

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