Haemorrhagic complications with adenotonsillectomy in children and young adults with bleeding disorders

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Haemorrhagic complications with adenotonsillectomy in children and young adults with bleeding disordersD. Warad1, F.T.N. Hussain2, A.N. Rao3, S.A. Cofer4 andV. Rodriguez3,*Article first published online: 12 JAN 2015

DOI: 10.1111/hae.12577

© 2014 John Wiley & Sons Ltd

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HaemophiliaEarly View (Online Version of Record published before inclusion in an issue)

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How to CiteWarad, D., Hussain, F.T.N., Rao, A.N., Cofer, S.A. and Rodriguez, V. (2015), Haemorrhagic complications with adenotonsillectomy in children and young adults with bleeding disorders. Haemophilia. doi: 10.1111/hae.12577

Author Information1

Special Coagulation Laboratory, Division of Hematopathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA

2

Department of Otolaryngology, Head and Neck Surgery, University of Minnesota, Minneapolis, MN, USA

3

Division of Pediatric Hematology Oncology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA

4

Division of Pediatric Otolaryngology, Department of Otolaryngology, Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA

* Correspondence: Vilmarie Rodriguez, MD, Director, Mayo Clinic Comprehensive Pediatric Hemophilia Center, 200 First Street SW, Rochester, MN 55905, USA.
Tel.: 507-284-2695; fax: 507-284-0727;
e-mail: rodriguez.vilmarie@mayo.edu

Publication HistoryArticle first published online: 12 JAN 2015Manuscript Accepted: 10 OCT 2014 SEARCH Search Scope All contentPublication titlesIn this journalIn this issue Search String Advanced >Saved Searches > SEARCH BY CITATION Volume: Issue: Page: ARTICLE TOOLSGet PDF (99K)Save to My ProfileE-mail Link to this ArticleExport Citation for this ArticleGet Citation AlertsRequest Permissions AbstractArticleReferencesCited By View Full Article (HTML) Enhanced Article (HTML) Get PDF (99K) Keywords:adenoidectomy;bleeding disorders;children;paediatric;postoperative haemorrhage;tonsillectomySummary

Haemorrhagic complications remain a challenge with surgical procedures in patients with bleeding disorders. In children and young adults, the most commonly performed surgeries are tonsillectomies and/or adenoidectomies. Adequate haemostasis in these patients with bleeding disorders is centred on comprehensive perioperative haemostatic support and dexterous surgical technique. The aim of this study was to assess postoperative bleeding complications with tonsillectomy and/or adenoidectomy in children and young adults with known bleeding disorders. Retrospective review of all patients aged <25 years with known bleeding disorders who underwent tonsillectomy and/or adenoidectomy at Mayo Clinic, Rochester MN between July 1992 and July 2012. In contrast to reported literature, we observed a higher rate of bleeding complications (10/19, 53%) despite aggressive haemostatic support and appropriate surgical techniques. Delayed bleeding (>24 h postoperatively) was more common than early bleeding; and recurrent bleeding was associated with older age. Children and young adults with haemorrhagic diatheses undergoing adenotonsillectomy are at a higher risk of delayed bleeding and require close monitoring with haemostatic support for a prolonged duration in the postoperative period. A uniform approach is needed to manage these patients perioperatively by establishing standard practice guidelines and ultimately reduce postsurgical bleeding complications.

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