Bleeding after tonsillectomy in severe von Willebrand's disease

A case is reported of a HIV-positive patient with severe von Willebrand's disease describing the bleeding complications during and after tonsillectomy. This patient underwent surgery for asymmetrical tonsillar hypertrophy. The tonsils were spontaneously haemorrhaging and there therefore was a suspicion of neoplasia. Despite close cooperation between the ENT Department and the Haemophilia Centre, involving per-operative Factor VIII monitoring and replacement, the patient suffered both protracted primary and secondary haemorrhages. We report this as a cautionary tale as our previous experience with mild to moderate haemophilia has been uncomplicated, but on this occasion there was massive haemorrhage. We feel that tonsillectomy should not be undertaken in a patient with a severe bleeding disorder without an absolute indicate.