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[Preoperative screening for the hemostatic system in ENT surgery in children]
M V Drozdova1, G S Maltzeva1, E V Tyrnova1
1Saint-Petersburg Research Institute of Ear, Throat, Nose and Speech, Ministry of Health of the Russian Federation, St.-Petersburg, Russia, 190013.
Insights
Children with chronic lymphoproliferative syndrome often experience bleeding after surgery due to platelet dysfunction. Early detection and comprehensive hemostasis testing are crucial for managing this risk.
Area of Science:
- Pediatric Hematology
- Oncology
- Surgical Complications
Background:
- Postoperative bleeding is a significant concern in children with chronic lymphoproliferative syndrome.
- Understanding the specific hemostatic abnormalities is vital for effective management.
Purpose of the Study:
- To analyze the causes of early and late postoperative bleeding in pediatric patients with chronic lymphoproliferative syndrome.
- To identify key hemostatic markers associated with bleeding complications.
Main Methods:
- Retrospective analysis of 71 children (1998-2018) with chronic lymphoproliferative syndrome undergoing surgery.
- Evaluation of platelet functional activity (aggregation), prothrombin time, activated partial thromboplastin time (APTT), and D-dimer levels.
- Correlation of bleeding events with medication use, specifically nonsteroidal anti-inflammatory drugs.
Main Results:
- Platelet functional disorders were observed in 83.8% of children, manifesting as impaired adrenaline-induced aggregation.
- Late bleeding (7-10 days post-op) was linked to nonsteroidal anti-inflammatory drug use, causing platelet dysfunction.
- Coagulation abnormalities included decreased prothrombin percent by Quick (73.5%), prolonged APTT (25%), and elevated D-dimer (1.5-2 fold) during bleeding episodes.
Conclusions:
- Routine preoperative screening including platelet count, prothrombin time, APTT, and fibrinogen is recommended.
- An extended hemostasis study assessing platelet adhesive, aggregative, and secretory functions is advised for patients with abnormal screening tests.
- Proactive hemostatic assessment can mitigate the risk of postoperative bleeding in this vulnerable pediatric population.
Abstract:
The analysis (1998-2018) of the causes of early postoperative bleeding in 68 children with chronic lymphoproliferative syndrome and late postoperative bleeding (on the 7-10th day) in 3 children aged 3 to 17 years was performed. It was found the disorder of the platelet functional activity (adrenaline-induced platelet aggregation, adrenaline concentration - 2.5 µmol/l) in 83.8% cases (57 children). Late postoperative bleedings were developed due to the uncontrolled intake of nonsteroidal anti-inflammatory painkillers, which led to the platelet dysfunction. It has been established the decrease in the prothrombin percent by Quick in 73.5% children, and the elongation of the activated partial thromboplastin time (APTT) in the quarter of children amid the bleeding. Half of the children showed the increase of D-dimer concentration to 1.5-2 fold amid the bleeding. We offer preoperative examination: platelet count, prothrombin percent by Quick (prothrombin time), APTT and fibrinogen level. We recommend an extended hemostasis study with the detection of adhesive, aggregative and secretory functions of platelets in the children with chronic lymphoproliferative syndrome if the results of the integral screening tests differ from normal range.
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