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Tonsillectomy is often the first haemostatic challenge for a child. Postoperative haemorrhage may therefore represent the first presentation of a child’s underlying bleeding disorder. This study aimed to quantify the rate of occult coagulopathy in patients who had experienced a post-tonsillectomy haemorrhage (PTH). In total, 250 children who had experienced a PTH without a previous diagnosis of coagulopathy were included in the analysis; 227 (91%) had a single episode of bleeding, while the remaining 23 (9%) had multiple PTHs. Coagulation screens were found to be abnormal in 71 (41%) of patients having a PTH. Following investigation by haematologists, a diagnosis of coagulopathy was made in three individuals (1%) all of whom had recurrent PTH. Two children received a diagnosis of von-Willebrands disease (VWD) and one had a diagnosis of ADP-related platelet defect. The observed rate of VWD in the sample was 0.8% which is within the estimated incidence of VWD in the general population (0.8-1.3%). However, when separating patients with multiple bleeding events, a significantly higher rate of coagulopathy was observed. The rate of occult coagulopathy was 13% in the group of children with multiple bleeding events, with 8.7% having VWD. Obtaining coagulation panels in children presenting with a single PTH is therefore rarely useful and diagnosing a coagulopathy is uncommon. However, among children with a second PTH, referral to haematology is reasonable as this group has a significantly higher incidence of undiagnosed bleeding disorders.

Post-Tonsillectomy Hemorrhage and the Diagnosis of Occult Pediatric Coagulopathies.
Chorney SR, Weinberger R, Weintraub AY, Buzi A.
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