Coagulation profile as a predictor for post-tonsillectomy and adenoidectomy (T + A) hemorrhage

The risk of hemorrhage after tonsillectomy and adenoidectomy (T + A) was studied in 1061 children. Twenty-seven (2.5%) had at least one abnormality on a preoperative coagulation profile consisting of a prothrombin time (PT), partial thromboplastin time (PTT), bleeding time (BT) and platelet count (PC). Of these 27 who had an initially abnormal test (PTT or bleeding times only), 8 had diagnosed coagulopathies by hematology evaluation (Group A), and 17 had repeat tests which returned to normal (Group B). Two borderline tests (PTT) were not repeated (Group C). Sixty-four patients (6.0%) bled after T + A. Six of these (9.3%) had an initially abnormal coagulation profile--one in Group A (12.5%), four in Group B (23.5%) and 1 in Group C (50%). This is in contrast to the bleed rate of 5.7% for the 1034 children with normal coagulation profiles. Although it is not surprising that 6 (22.2%) children with an initially abnormal coagulation profile bled, of note is that 4 of them had an initially abnormal coagulation profile which upon repeat testing returned to normal. However, none of these four bleeders required active intervention for control. Coagulopathies were newly diagnosed in 7 (0.57% of total group; 25.9% of 27 with abnormal laboratory values). One additional child had a known intrinsic platelet dysfunction prior to surgery. Only one child was newly identified by a positive family history for abnormal bleeding. These results suggest that new hematologic disorders were diagnosed infrequently. An initially abnormal coagulation profile may identify those more likely to bleed after surgery (22.6% vs. 5.5%). A coagulation profile which includes a PTT and BT may be a valuable screening tool for children undergoing T + A.