Coagulation Panels Rarely Useful to Detect Pediatric Occult Coagulopathy Before Post-Tonsillectomy Hemorrhage

by Linda Kossoff •

What is the rate of occult coagulopathy diagnosed after post-tonsillectomy hemorrhage (PTH) in children?

BOTTOM LINE: Obtaining coagulation panels in pediatric patients presenting with PTH is rarely useful and diagnosing a coagulopathy is uncommon, but referral to hematology is reasonable among children with a second PTH.

BACKGROUND: Post-tonsillectomy hemorrhage occurs in approximately 1.5% to 4.5% of surgeries. Obtaining coagulation panels prior to surgery for underlying hemostatic disease in patients would be of value to surgeons; however, a correlation between abnormal coagulation studies and rates of PTH has not been defined.

STUDY DESIGN: Case series with chart review.

SETTING: Department of Otolaryngology–Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas.

SYNOPSIS: Researchers identified the medical records of pediatric patients with no known history of coagulopathy or suspecting bleeding disorder presenting for surgical management of a PTH between January 2015 and September 2019. The researchers recorded data on 250 patients, including screening panels for coagulopathy and hematology notes on those who were referred following the PTH event(s). Of the 250, 227 children had one PTF, 23 had two PTFs, and three had three PTFs. Thirty-eight of the children were referred to hematology. The prevalence of an occult coagulopathy diagnosis in the overall cohort was 1.2% but rose to 13% when separating those patients with multiple bleeding events. Within this cohort, 8.7% had von Willebrand disease. Researchers assessed these results to be in the normal range for a general population and noted that the children who were diagnosed with a coagulopathy did not show clotting abnormalities on their initial screening. They concluded that obtaining coagulation panels in these patients is rarely useful, although referral to hematology is reasonable among children with multiple bleeding events. Study limitations included inherent selection bias within the retrospective design.

CITATION: Chorney SR, Weinberger R, Weintraub AY, et al. Post-tonsillectomy hemorrhage and the diagnosis of occult pediatric coagulopathies [published online ahead of print November 4, 2020]. Laryngoscope. doi: 10.1002/lary.29244.