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Bleeding Outcomes After Adenotonsillar Surgery in Pediatric Patients With Hemophilia: Perioperative Management and

Shaked Shivatzki1,2, Sarina Levy-Mendelovich3,4, Idit Tessler1,2

  • 1Department of Otolaryngology and Head and Neck Surgery, Sheba Medical Center, Ramat Gan, Israel.

Pediatric Blood & Cancer
|July 29, 2026
PubMed

Insights

Perioperative management significantly reduces post-tonsillectomy bleeding (PTB) in pediatric hemophilia patients. Strict protocols involving antifibrinolytic therapy and factor replacement are effective for this high-risk group.

Area of Science:

  • Pediatric Surgery
  • Hematology
  • Hemostasis

Background:

  • Adenotonsillectomy is common in children, but post-tonsillectomy bleeding (PTB) is a risk.
  • Pediatric patients with hemophilia face higher risks of delayed hemorrhage after surgery.

Purpose of the Study:

  • To investigate PTB incidence in pediatric hemophilia patients.
  • To evaluate the effectiveness of perioperative management strategies for adenotonsillectomy in this population.

Main Methods:

  • Retrospective review of medical records (January 2010 - January 2024).
  • Analysis of 18 pediatric hemophilia patients undergoing adenotonsillectomy.
  • Assessment of PTB rates and comparison of perioperative treatment protocols.

Main Results:

  • Only one case of epistaxis observed among 18 patients.
  • Hemostatic management included antifibrinolytic therapy and preoperative clotting factor replacement.
  • Postoperative care involved continued antifibrinolytic therapy and factor replacement for an average of 5 days, with minimal significant bleeding.

Conclusions:

  • Stringent perioperative protocols can potentially decrease PTB incidence in pediatric hemophilia patients.
  • Effective management strategies are crucial for this high-risk population.
  • Further research is needed to optimize management protocols.
Abstract

Keywords:
adenotonsillectomyhemophiliapediatricpost‐tonsillectomy bleed

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