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Unexplained bleeding after any surgery is least desirable and to identify a cause for this preoperatively can be a very useful safeguarding measure. By looking for inherited platelet disorders in patients who bled after tonsillectomy, the authors of this publication have demonstrated one of the ways to acquire this safeguard. In this study comprising 91 patients who bled after tonsillectomy, five had platelet disorders (5.49%). There were three with Von Willebrand disease and two with ‘other platelet disorders’. Patients with normal collagen and adrenaline cartridge closure times, or prolonged collagen and adrenaline closure time but normal collagen and adenosine diphosphate cartridge closure times, were defined as true negatives. Platelet dysfunction, secondary to NSAID (most commonly used for post tonsillectomy analgesia), was ruled out as false positive by repeat platelet function analyser 100 testing (PFA100) after stopping the NSAID. None of the patients with normal PFA100 were later found to have a platelet disorder, hence there were no false negatives. One of the questions opened by this study is whether all patients undergoing tonsillectomy should have this inexpensive PFA100 test, considering the high costs of prolonged hospitalisation and blood transfusion, if needed. This also provokes a thought that use of PFA100 test in post-tonsillectomy bleeding may identify a platelet dysfunction, regardless of a heredity disorder or use of NSAID, and justify immediate use of tranexamic acid, possibly preventing return to theatre.

Platelet function testing in patients with post-operative tonsillectomy bleeding may be a useful early identifier of inherited platelet function disorders.
James TW, Thomson BJ, Naumann DN, Stevenson DS.
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Madhup K Chaurasia

Mid and South Essex NHS Foundation Trust, UK.

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