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Detecting coagulopathy in pediatric patients with post-tonsillectomy hemorrhage
Anisha Konanur1, Jennifer L McCoy2, Amber Shaffer2
1University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
International Journal of Pediatric Otorhinolaryngology
|June 30, 2021
Summary
Routine lab work in the emergency department for post-tonsillectomy hemorrhage (PTH) rarely uncovers new coagulopathies. While anemia and thrombocytosis are common, they seldom require intervention, highlighting the need for guided testing protocols.
Area of Science:
- Pediatric Emergency Medicine
- Hematology
- Otolaryngology
Background:
- Post-tonsillectomy hemorrhage (PTH) is a significant complication following tonsillectomy.
- Previous studies indicate limited utility of routine laboratory investigations for PTH.
- This study evaluates the diagnostic yield of emergency department (ED) lab work for identifying previously unknown coagulopathies in pediatric PTH patients.
Purpose of the Study:
- To determine the frequency and types of laboratory tests performed in the ED for pediatric patients presenting with PTH.
- To assess the incidence of newly diagnosed coagulopathies in this patient population.
- To evaluate the clinical significance of common lab abnormalities found in PTH.
Main Methods:
- Retrospective chart review of pediatric patients (2017-2019) presenting to a tertiary care children's ED after tonsillectomy.
- Exclusion criteria included no bleed, known coagulopathy, outside treatment, or age ≥18.
- Laboratory tests analyzed included complete blood count (CBC), prothrombin time (PT), partial thromboplastin time (PTT), and von Willebrand factor (VWF).
Main Results:
- Of 364 eligible patients, 91.8% had ED labs drawn. Anemia (19.1%) and thrombocytosis (13.8%) were the most frequent abnormalities.
- Elevated PTT (3.0%) and PT (2.4%) were less common. Only 2.1% of patients with ED labs had an uncovered coagulopathy.
- Hematology consultation led to diagnoses of von Willebrand disease (n=6) and factor VII deficiency (n=1). Operative intervention was needed in 18.7% of patients, with no significant difference in lab abnormalities.
Conclusions:
- Incidental coagulopathies are infrequently identified in pediatric patients presenting with PTH.
- Anemia and thrombocytosis are common findings but rarely necessitate transfusion or operative intervention.
- Developing evidence-based algorithms is crucial for optimizing laboratory testing and value-based care in PTH management.
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