Stellenwert der Blutabnahme vor Adenotomie

Zusammenfassung

Hintergrund: Die gemeinsame Stellungnahme der Gesellschaften für Hals-Nasen- und Ohrenheilkunde, Pädiatrie sowie Anästhesie zur Notwendigkeit präoperativer Gerinnungsdiagnostik vor Adenotomien und Tonsillektomien bei Kindern veranlasste uns, eine retrospektive Analyse unseres Patientengutes durchzuführen.

Methode und Patienten: Retrospektiv wurden Daten von 1137 Patienten analysiert, die in 2005 und 2006 in unserer Klinik eine Adenotomie erhalten hatten. Neben dem Geschlecht, Alter, Hb, Thrombozytenzahl, Quick, INR, PTT, TZ wurde auch der klinische Verlauf erfasst.

Ergebnisse: Pathologische Werte fanden sich in 3 % aller Laboruntersuchungen, aber nur 0,12 % der Parameter hatten als Konsequenz, dass keine Operation stattfand. Aufgrund auffälliger Laborparameter erfolgte somit in 7 Fällen kein Eingriff. Hierbei handelte es sich in je drei Fällen um eine Thrombozytopenie (< 100 000 Zellen/µl) sowie um eine Anämie (Hb < 10 g/dl) und in einem Fall um eine PTT-Verlängerung. Drei dieser Patienten konnten zu einem späteren Zeitpunkt operiert werden. Insgesamt wurden 11 AT-Nachblutungen beobachtet und z. T. operativ (6) versorgt. Bei diesen 11 Patienten mit AT-Nachblutungen lagen die Thrombozytenzahlen und die anderen bestimmten Gerinnungsparameter im Normbereich.

Schlussfolgerungen: Aufgrund der hier vorgestellten Daten und der aktuellen Literatur ist eine Blutanalysen nur bei Patienten mit einer auffälligen Blutungsanamnese oder Anämie oder einer auffälligen Familienanamnese erforderlich. Die standardisierte präoperative Dokumentation der Blutungsanamnese in den Krankenunterlagen wird dringend empfohlen.

Abstract

Background: Hörmann recently published a joint statement of the German Societies of Oto-Rhino-Laryngology, Head and Neck surgery, of pediatrics and of anesthesiology regarding the necessity of coagulation tests prior to adenoidectomy or tonsillectomy in children. According to many studies, these societies agreed that coagulation tests should be performed only in children with an unusual bleeding history. We analyzed our adenoidectomy-database to investigate the need for preoperative blood tests to prevent bleeding events during and following an adenoidectomy. Methods and Patients: Data of 1137 children were collected, undergoing adenoidectomy during a period of 18 months (2005/2006) at the Bochum department of Oto-Rhino-Laryngology, retrospectively. Information on sex, age, hemoglobin concentration, platelet count, INR, thromboplastin time and prothrombin time and clinical bleeding history were collected. Results: 3 % of the laboratory investigations showed pathological parameters. Only 0.12 % of the tests resulted in the cancellation of the operation (7 cases). The reasons for cancellation were: platelet count less than 100 000/µl (3 patients), anemia (Hb < 10 g/dl) (3 patients) and prolongated thromboplastin time (1 patient). 3 of these 7 patients were operated later on. Postoperative hemorrhage was noticed in 11 patients following adenoidectomy. In these 11 patients with bleeding complications all laboratory parameters were found to be normal. Conclusions: In accordance with the current literature our data show that bleeding after adenoidectomy is a rare complication. In contrast to many other studies, we also report weak bleedings from the epipharynx. Blood tests were routinely performed prior to every operation with little benefit. Only 4 patients were definitely not scheduled for surgery as a consequence of the preoperative blood test. Patients with bleeding complications were not suspicious regarding laboratory workup. We therefore conclude that blood tests prior to adenoidectomy have no relevance for the course of the operation and postoperative bleeding event. Blood tests should only be performed on patients with an unusual bleeding history, family bleeding history or indications for anemia. The documentation of a standardized bleeding history prior to surgery is strongly recommended.

Schlüsselwörter

Adenotomie - präoperative Blutabnahme - Gerinnungsdiagnostik - Inzidenz von Nachblutungen - operatives Management von Nachblutungen aus dem Epipahyrnx - Anamnesebogen zur Blutungsneigung

Key words

adenoidectomy - preoperative blood tests - coagulation tests - incidence of bleedings - operative management of bleedings from the epipharynx

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