Introduction: The most serious complication of tonsillectomy is haemorrhage. Primary post-tonsillectomy bleeding occurs during the first 24 hours following the procedure as a consequence of inadequate suturing/ligation of the feeding arteries. Secondary post-tonsillectomy bleeding occurs most frequently between the 5-8. postoperative days. The role of different risk factors has intensively been examined in the background of secondary post-tonsillectomy bleedings, however, their real role is rather confusing.
Aim: The aim of the present study was to examine whether preoperative haematological screening in order to detect hidden coagulopathies in the background of post-tonsillectomy bleedings is reasonable or not.
Method: Of the 115 patients who were admitted to the Department of Otorhinolaryngology, Head and Neck Surgery, Medical School, University of Pécs, between 2002 and 2004, 107 patients (59 female, 48 male, average age 29+/-10.9 years) were asked to undergo screening of the following factors: thrombocytes, bleeding time using the Ivy method, thrombin time, activated partial prothrombin time, prothrombin/INR ratio, fibrinogen level.
Results: Of the 58 patients who accepted the invitation 28 (49%) presented with abnormal screening results. Isolated factor determination was recommended to all of them, however, only 19 patients (68%) turned up for the second screening. In 2 cases--3.4% of the re-examined patients--unknown coagulopathy was diagnosed: isolated factor VII underproduction in 1 patient and combined factor VII and XII underproduction also in 1 patient. Three female patients presented with a surprising isolated factor IX overproduction which proned them to thrombosis: all 3 patients had been on oral anticoncipients.
Conclusions: From this study several conclusions can be drown for the practising physician: 1. the universal preoperative haematological screening does not seem to be cost-effective; 2. in cases of children, especially if the family history and also both the preoperative history and detailed physical examination are suspicious (e.g. recurrent mild nasal bleedings!) hidden coagulopathy needs to be ruled out; 3. in our study activated partial thromboplastin time seemed to be the most sensitive screening parameter; 4. due to the fact that coagulopathies are inherited diseases, the diagnosis of a patient with a particular hidden coagulopathy can contribute to the exploration of further family members; 5. the vast majority of secondary post-tonsillectomy bleedings were observed after procedures which had been carried out with "hot" techniques: bipolar forceps or bipolar scissors; 6. Ivy's method is the recommended method of choice to examine the bleeding time.