Hemorrhagic Complications With Adenotonsillectomy In Children and Young Adults With Bleeding Disorders

Abstract Hemorrhagic complications remain a challenge with surgical procedures in patients with bleeding disorders. Tonsillectomy and adenoidectomy are some of the most common surgical procedures performed in pediatric patients. Adequate hemostasis in patients with bleeding disorders is centered on comprehensive hemostatic support and dexterous surgical technique. To assess our institutional experience with children and young adults with bleeding disorders that underwent tonsillectomy and/or adenoidectomy we performed a retrospective chart review of all such patients (age 24 hours) bleeding from surgical site. Bleeding resolved spontaneously in 2 patients while 8 patients (42%) required interventions such as cauterization (4 patients), extended aminocaproic acid dosing (4 patients), DDAVP (1 patient), DDAVP and tranexamic acid (1 patient), recombinant factor VII (1 patient), Humate-P® (1 patient), Factor VIII infusion (1 patient) and Factor IX infusion (1 patient). Three patients (30% of bleeding patients) required transfusions including 1 patient that received platelet transfusions, 1 patient received PRBCs and another patient received FFP. Recurrent bleeding was noted in 3 patients and the rate was significantly higher in older patients amongst those with bleeding complications (p=0.0189). Table 1 . Age (years, months) Gender Diagnosis Severity of disease Post-operative bleeding (Early ≤ 24 hours, Delayed >24 hours) Recurrent bleeding 14,5 M Essential Thrombocythemia Moderate Early Yes 13,6 M Factor VII deficiency Mild Delayed No 6,7 F Factor VII deficiency Mild Delayed No 7,6 F Factor VII deficiency Mild No - 11,2 F Factor XI deficiency Mild Early No 8,4 M Hemophilia A Severe Delayed No 9,4 F Hemophilia A carrier Mild Delayed No 15,2 F Hemophilia A carrier Mild No - 5,0 M Hemophilia B Mild No - 23,2 M Hemophilia B Mild Delayed Yes 6,1 F Hemophilia B carrier Mild No - 6,8 F Hemophilia B carrier Mild No - 15,2 F Hemophilia B carrier Mild No - 11,4 F May-Hegglin anomaly Moderate Delayed No 4,0 F Type 1 von Willebrand Mild Delayed No 13,5 F Type 2A von Willebrand Moderate Delayed Yes 2,5 M Type 2A von Willebrand Moderate No - 9,9 F Type 2B von Willebrand Moderate No 9,1 F Type III von Willebrand Severe No - The rate of bleeding complications in pediatric patients with mild bleeding disorders undergoing adenotonsillectomy has been reported to be similar to that of normal population. In our cohort, delayed bleeding was more common than early bleeding consistent with current literature. We observed a higher rate of bleeding complications (53%) than reported in literature despite aggressive hemostatic support and adequate surgical techniques; however, our sample size was limited. Although there was no association between delayed hemorrhage and age, recurrent bleeding was associated with older age. We conclude that patients with bleeding disorders undergoing adenotonsillectomy are at a higher risk of bleeding and require close monitoring with hemostatic support for a prolonged period of time in post-operative period. Disclosures: No relevant conflicts of interest to declare.