COAGULATION PROFILE AS A PREDICTOR FOR POST-TONSILLECTOMY AND ADENOIDECTOMY (T+A) HEMORRHAGE

The risk of hemorrhage after tonsillectomy and adenoidectomy (T + A) w as studied in 1061 children. Twenty-seven (2.5%) had at least one abno rmality on a preoperative coagulation profile consisting of a prothrom bin time (PT), partial thromboplastin time (PTT), bleeding time (BT) a nd platelet count (PC). Of these 27 who had an initially abnormal test (PTT or bleeding times only), 8 had diagnosed coagulopathies by hemat ology 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%) h ad an initially abnormal coagulation profile-one in Group A (12.5%), f our 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 p rofiles. Although it is not surprising that 6 (22.2%) children with an initially abnormal coagulation profile bled, of note is that 4 of the m had an initially abnormal coagulation profile which upon repeat test ing returned to normal. However, none of these four bleeders required active intervention for control. Coagulopathies were newly diagnosed i n 7 (0.57% of total group; 25.9% of 27 with abnormal laboratory values ). One additional child had a known intrinsic platelet dysfunction pri or to surgery. Only one child was newly identified by a positive famil y history for abnormal bleeding. These results suggest that new hemato logic disorders were diagnosed infrequently. An initially abnormal coa gulation profile may identify those more likely to bleed after surgery (22.6% vs. 5.5%). A coagulation profile which includes a PTT and BT m ay be a valuable screening tool for children undergoing T + A.