Download PDF
Hamostaseologie 2009; 29(01): 64-67
DOI: 10.1055/s-0037-1616942
Original article
Schattauer GmbH

Haemostatic testing prior to elective surgery in children? Not always!

C. Bidlingmaier
1   Dr. von Hauner’s University Children’s Hospital Munich, Germany
,
W. Eberl
2   Children‘s Hospital Braunschweig, Germany
,
R. Knöfler
3   University Children’s Hospital Dresden, Germany
,
M. Olivieri
1   Dr. von Hauner’s University Children’s Hospital Munich, Germany
,
K. Kurnik
1   Dr. von Hauner’s University Children’s Hospital Munich, Germany
› Author Affiliations
Further Information

Publication History

Publication Date:
08 January 2018 (online)

Also available at
    Permissions and Reprints

Summary

In Germany, preoperative coagulation tests are commonly used, based on the belief that these tests should identify patients with an increased bleeding risk. However, published evidence does not longer support this approach for both traditional screening tests and novel techniques of global assessment of haemostasis. Unselected screening yields many false positive results and detects irrelevant disorders. It leads to postponement of surgery, anxiety in parents and patients, and is not cost effective. Even worse, it does not reliably detect relevant bleeding disorders such as the most common coagulopathy, von Willebrand disease. The bleeding history of patients and their relatives is a more effective tool to detect patients at risk. According to international guidelines and a joint statement of different German medical societies, a standardized questionnaire should be mandatory in preoperative screening. A diagnostic pathway should be employed to identify patients in whom specific tests are helpful. Because neither laboratory tests nor questionnaires can infallibly predict or exclude perioperative bleeding, guidelines for the management of these unexpected situations have to be established.

Keywords

Coagulation tests
 

  • References

  • 1 American Academy of Otolaryngology – Head and Neck Surgery.. Clinical Indicators Compendium: Tonsillectomy. Alexandria, VA: American Academy of Otolaryngology – Head and Neck Surgery Inc.; 1999 http://www.entnet.org/Practice/indicators/tonsillectomy.html .
    PubMedGoogle Scholar
  • 2 Bidlingmaier C, Eberl W, Knöfler R, Kurnik K. Präoperative Diagnostik: Warum die PTT nicht reicht. HNO-Nachrichten 2008; 3: 26-31.
    PubMedGoogle Scholar
  • 3 Bidlingmaier C, Eberl W, Kurnik K. Preoperative coagulation screening in children. Paediat Prax 2007; 70: 41-47.
    PubMedGoogle Scholar
  • 4 Bidlingmaier C, Sax F, Treutwein J, Kurnik K. The PTT ist not enough – preoperative coagulation screening in children. Thromb Haemost 2007; 5: P-S-221.
    PubMedGoogle Scholar
  • 5 Brökelmann J, Reydelet J. Zahl der Operationen in Deutschland 2003 – eine Annäherung. Ambulant operieren 2005; 2: 95-102.
    PubMedGoogle Scholar
  • 6 Chee YL, Crawford JC, Watson HG, Greaves M. Guidelines on the assessment of bleeding risk prior to surgery or invasive procedures. British Committee for Standards in Haematology. Br J Haematol 2008; 140: 496-504.
    CrossrefPubMedGoogle Scholar
  • 7 Chee YL, Greaves M. Role of coagulation testing in predicting bleeding risk. Hematol J 2003; 4: 373-378.
    CrossrefPubMedGoogle Scholar
  • 8 Derkay CS. A cost-effective approach for preoperative hemostatic assessment in children undergoing adenotonsillectomy. Arch Otolaryngol Head Neck Surg 2000; 126: 688.
    CrossrefPubMedGoogle Scholar
  • 9 Deutsche Gesellschaft für Hals-Nasen-OhrenHeilkunde, Kopf und Halschirurgie.. Adenoide Vegetationen. AWMF-Leitlinien-Register. 2001 Nr. 017/021.
    PubMedGoogle Scholar
  • 10 Deutsche Gesellschaft für Hals-Nasen-OhrenHeilkunde, Kopf und Halschirurgie.. Chronische Tonsillitis. AWMF-Leitlinien-Register. 2001 Nr. 017/024.
    PubMedGoogle Scholar
  • 11 Eberl W. Präoperative Gerinnungsdiagnostik: Risikokinder verlässlich identifizieren. Paediatrie hautnah 2006; 1: 27-32.
    PubMedGoogle Scholar
  • 12 Eberl W, Schwarte S, Schrader M. Thrombelastography is not suitable to detect Willebrand disease. Hämostaseologie 2008; 28: S84-S85.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 13 Eberl W, Wendt I, Schroeder H-G. Präoperatives Screening auf Gerinnnungsstörungen vor Adenotomie und Tonsillektomie. Klin Pädiatr 2005; 217: 20-24.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 14 Hörmann K. Joint statement on the need for pre-operative coagulation tests before adenotomy and tonsillectomy in children. Laryngorhinootologie 2006; 85: 580-581.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 15 Kamal AH, Tefferi A, Pruthi RK. How to interpret and pursue an abnormal prothrombin time, activated partial thromboplastin time, and bleeding time in adults. Mayo Clin Proc 2007; 82: 864-873.
    CrossrefPubMedGoogle Scholar
  • 16 Kitchens CS. To bleed or not to bleed? Is that the question for the PTT?. J Thromb Haemost 2005; 3: 2607-2611.
    CrossrefPubMedGoogle Scholar
  • 17 Klinge J, Eberl W, Lischtzki G. Die präoperative aPTT-Verlängerung. Paediat Prax 2004; 65: 57-66.
    PubMedGoogle Scholar
  • 18 Koscielny J, Ziemer S, Radtke H. et al. A practical concept for preoperative identification of patients with impaired primary hemostasis. Clin Appl Thromb Hemost 2004; 10: 195-204.
    CrossrefPubMedGoogle Scholar
  • 19 Krishna P, Lee D. Post-tonsillectomy bleeding: a meta-analysis. Laryngoscope 2001; 111: 1358-1361.
    CrossrefPubMedGoogle Scholar
  • 20 Licameli GR, Jones DT, Santosuosso J. et al. Use of a preoperative bleeding questionnaire in pediatric patients who undergo adenotonsillectomy. Otolaryngol Head Neck Surg 2008; 139: 546-550.
    CrossrefPubMedGoogle Scholar
  • 21 Lillicrap D, Nair SC, Srivastava A. et al. Laboratory issues in bleeding disorders. Haemophilia 2006; 12: S68-S75.
    PubMedGoogle Scholar
  • 22 Lowe D, van der Meulen J. Tonsillectomy technique as a risk factor for postoperative haemorrhage. Lancet 2004; 364: 697-702.
    CrossrefPubMedGoogle Scholar
  • 23 National Institute for Clinical Excellence.. Pre-operative Tests: The use of routine preoperative tests for elective surgery. 2003 CG003. www.nice.org.uk/nicemedia/pdf/Preop_Fullguideline.pdf
    PubMedGoogle Scholar
  • 24 Österreichische Gesellschaft für Hals-NasenOhrenheilkunde, Kopf und Halschirurgie.. Verhalten bei Nachblutung nach Mandeloperation. 2007 www.hno.at/fileadmin/hno/pdfs/Merkblatt_Verhalten_bei_Nachblutung_nach_TE.pdf
    PubMedGoogle Scholar
  • 25 Pfanner G, Koscielny J, Pernerstorfer T. et al. Pre-operative evaluation of the bleeding history. Recommendations of the working group on perioperative coagulation of the Austrian Society for Anaesthesia, Resuscitation and Intensive Care. Anaesthesist 2007; 56: 604-611.
    CrossrefPubMedGoogle Scholar
  • 26 Rodeghiero F, Castaman G, Tosetto A. et al. The discriminant power of bleeding history for the diagnosis of type 1 von Willebrand disease: an international, multicenter study. J Thromb Haemost 2005; 3: 2619-2626.
    CrossrefPubMedGoogle Scholar
  • 27 Roschitz B, Thaller S, Koestenberger M. et al. PFA-100 closure times in preoperative screening in 500 pediatric patients. Thromb Haemost 2007; 98: 243-247.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 28 Scheckenbach K, Bier H, Hoffmann TK. et al. Risk of hemorrhage after adenoidectomy and tonsillectomy. Value of the preoperative determination of partial thromboplastin time, prothrombin time and platelet count. HNO 2008; 56: 312-320.
    CrossrefPubMedGoogle Scholar
  • 29 Schwaab M, Hansen S, Gurr A, Dazert S. Significance of blood tests prior to adenoidectomy. Laryngorhinootologie 2008; 87: 100-106.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 30 Shaw PH, Reynolds S, Gunawardena S. et al. The prevalence of bleeding disorders among healthy pediatric patients with abnormal preprocedural coagulation studies. J Pediatr Hematol Oncol 2008; 30: 135-141.
    CrossrefPubMedGoogle Scholar
  • 31 Strauß J, Becke K, Schmidt J. Gerinnungs -störungen: Auf die Anamnese kommt es an. Deutsches Ärzteblatt 2006; 103: B1670.
    PubMedGoogle Scholar
  • 32 Stuck BA, Genzwurker HV. Tonsillectomy in children: preoperative evaluation of risk factors. Anaesthesist 2008; 57: 499-504.
    CrossrefPubMedGoogle Scholar
  • 33 Suchman AL, Griner PF. Diagnostic uses of the activated partial thromboplastin time and prothrombin time. Ann Intern Med 1986; 104: 810-816.
    CrossrefPubMedGoogle Scholar
  • 34 Watson HG, Greaves M. Can we predict bleeding?. Semin Thromb Hemost 2008; 34: 97-103.
    PubMedGoogle Scholar
  • 35 Wei JL, Beatty CW, Gustafson RO. Evaluation of posttonsillectomy hemorrhage and risk factors. Otolaryngol Head Neck Surg 2000; 123: 229-235.
    CrossrefPubMedGoogle Scholar
  • 36 Windfuhr JP, Chen YS, Remmert S. Unidentified coagulation disorders in post-tonsillectomy hemorrhage. Ear Nose Throat J 2004; 83: 28 30, 32.
    PubMedGoogle Scholar