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Bleeding after tonsillectomy in severe von Willebrand's disease
G H Alusi1, W E Grant, C A Lee
1Department of Otolaryngology, Head and Neck Surgery, Royal Free Hospital, School of Medicine, London.
The Journal of Laryngology and Otology
|May 1, 1995
Summary
Tonsillectomy in patients with severe von Willebrand disease poses significant bleeding risks. This case highlights the potential for severe, protracted hemorrhages despite Factor VIII management, advising against the procedure without absolute indication.
Area of Science:
- Hematology
- Otolaryngology
Background:
- Von Willebrand disease (VWD) is a genetic bleeding disorder.
- Human Immunodeficiency Virus (HIV) infection can complicate management of bleeding disorders.
Observation:
- A case of an HIV-positive patient with severe VWD undergoing tonsillectomy for asymmetrical tonsillar hypertrophy.
- Spontaneous tonsillar hemorrhage raised suspicion for neoplasia.
Findings:
- The patient experienced severe primary and secondary hemorrhages post-tonsillectomy.
- Despite perioperative Factor VIII monitoring and replacement, bleeding was protracted.
- This contrasts with uncomplicated experiences in mild to moderate hemophilia.
Implications:
- Tonsillectomy in severe VWD patients carries substantial hemorrhage risk.
- Careful consideration and absolute indication are necessary before performing tonsillectomy in severe bleeding disorders.
- Multidisciplinary collaboration between ENT and Hematology is crucial.