Hostname: page-component-cd9895bd7-fscjk Total loading time: 0 Render date: 2024-12-28T02:02:16.811Z Has data issue: false hasContentIssue false
  • English
  • Français

Platelet function testing in patients with post-operative tonsillectomy bleeding may be a useful early identifier of inherited platelet function disorders

Published online by Cambridge University Press:  05 October 2020

T W James ,
B J Thomson ,
D N Naumann  and
D S Stevenson
T W James*
Affiliation:
Department of Otolaryngology, University Hospitals Birmingham NHS Foundation Trust, UK
B J Thomson
Affiliation:
Department of Otolaryngology – Head and Neck Surgery, Christchurch Hospital, New Zealand
D N Naumann
Affiliation:
Department of Otolaryngology, University Hospitals Birmingham NHS Foundation Trust, UK
D S Stevenson
Affiliation:
Department of Otolaryngology – Head and Neck Surgery, Christchurch Hospital, New Zealand
*
Author for correspondence: Mr Tobias W James, Department of Otolaryngology, University Hospitals Birmingham NHS Foundation Trust, UK E-mail: tobias.james@nhs.net
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Post-tonsillectomy bleeding is the most frequent complication of tonsillectomy. Inherited platelet function disorders have an estimated prevalence of 1 per cent. Any association between post-tonsillectomy bleeds and undiagnosed inherited platelet function disorders has not been investigated before.

Objectives

To assess the prevalence of inherited platelet function disorders in a cohort of post-tonsillectomy bleed patients.

Methods

An observational cohort study was conducted using hospital digital records. Platelet function analyser 100 (‘PFA-100’) closure time was tested on post-tonsillectomy bleed patients who presented to hospital.

Results

Between 2013 and 2017, 9 of 91 post-tonsillectomy bleed patients who underwent platelet function analyser 100 testing (9.89 per cent) had positive results. Five patients (5.49 per cent) had undiagnosed inherited platelet function disorders. Four patients had false positive results secondary to a non-steroidal anti-inflammatory drug effect (specificity of 95.3 per cent) proven by repeat testing six weeks later, off medication. The false negative rate was 0 per cent.

Conclusion

The prevalence of inherited platelet function disorders in our post-tonsillectomy bleed cohort is five-fold higher than in the general population. Platelet function analyser 100 testing when patients present with a post-tonsillectomy bleed allows management of their inherited platelet function disorder.

Keywords

TonsillectomyBlood Platelet DisordersPlatelet Function TestsVon Willebrand Disease
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 134 , Issue 10 , October 2020 , pp. 882 - 886
Copyright
Copyright © The Author(s), 2020. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

Mr T W James takes responsibility for the integrity of the content of the paper

Presented at the New Zealand Society of Otolaryngology, Head and Neck Surgery Annual Scientific Meeting, 19 October 2018, Queenstown, New Zealand.

References

Windfuhr, JP. Serious complications following tonsillectomy: how frequent are they really? ORL J Otorhinolaryngol Relat Spec 2013;75:166–73CrossRefGoogle Scholar
British Association of Otorhinolaryngologists - Head and Neck Surgeons Comparative Audit Group, and Clinical Effectiveness Unit, Royal College of Surgeons of England. National Prospective Tonsillectomy Audit: Final Report of an Audit carried out in England and Northern Ireland between July 2003 and September 2004. London: Royal College of Surgeons of England, 2005Google Scholar
Manning, SC, Beste, D, McBride, T, Goldberg, A. An assessment of preoperative coagulation screening for tonsillectomy and adenoidectomy. Int J Pediatr Otorhinolaryngol 1987;13:237–44CrossRefGoogle ScholarPubMed
Roschitz, B, Thaller, S, Koestenberger, M, Wirnsberger, A, Leschnik, B, Fritsch, P et al. PFA-100 closure times in preoperative screening in 500 pediatric patients. Thromb Haemost 2007;98:243–7CrossRefGoogle ScholarPubMed
Kirchmaier, CM, Pillitteri, D. Diagnosis and management of inherited platelet disorders. Transfus Med Hemother 2010;37:237–46CrossRefGoogle ScholarPubMed
Marxsen, JH, Forchheim, S, Zuske-Matthäus, A, Wagner, T. Prevalence of platelet dysfunction and abnormal coagulation: results of a population-based study. Clin Appl Thromb Hemost 2009;15:421–7CrossRefGoogle ScholarPubMed
Roberts, LN, Patel, RK, Arya, R. Haemostasis and thrombosis in liver disease. Br J Haematol 2010;148:507–21CrossRefGoogle ScholarPubMed
Wohlauer, MV, Moore, EE, Thomas, S, Sauaia, A, Evans, E, Harr, J et al. Early platelet dysfunction: an unrecognized role in the acute coagulopathy of trauma. J Am Coll Surg 2012;214:739–46CrossRefGoogle ScholarPubMed
Rodeghiero, F, Castaman, G, Dini, E. Epidemiological investigation of the prevalence of von Willebrand's disease. Blood 1987;69:454–9CrossRefGoogle ScholarPubMed
Handin, RI. Inherited platelet disorders. Hematology 2005;2005:396–402CrossRefGoogle Scholar
Gudmundsdottir, BR, Marder, VJ, Onundarson, PT. Risk of excessive bleeding associated with marginally low von Willebrand factor and mild platelet dysfunction. J Thromb Haemost 2007;5:274–81CrossRefGoogle ScholarPubMed
Ziv, O, Ragni, MV. Bleeding manifestations in males with von Willebrand disease. Haemophilia 2004;10:162–8CrossRefGoogle ScholarPubMed
Environment Canterbury Regional Council. Culture and identity. In: https://www.ecan.govt.nz/your-region/living-here/regional-leadership/population/culture-and-identity/ [14 September 2020]Google Scholar
PFA-100 System. In: https://www.siemens-healthineers.com/en-us/hemostasis/systems/pfa-100 [14 September 2020]Google Scholar
Kweon, OJ, Lim, YK, Kim, B, Lee, M-K, Kim, HR. Effectiveness of platelet function analyzer-100 for laboratory detection of anti-platelet drug-induced platelet dysfunction. Ann Lab Med 2019;39:23–30CrossRefGoogle ScholarPubMed
Bolton-Maggs, P, Wilkinson, LS. Mild bleeding disorders: review of 120 patients. Clin Lab Haematol 1984;6:247–56Google ScholarPubMed
Favaloro, EJ, Bodó, I, Israels, SJ, Brown, SA. von Willebrand disease and platelet disorders. Haemophilia 2014;20:59–64CrossRefGoogle ScholarPubMed
Krishna, S, Hughes, LF, Lin, SY. Postoperative hemorrhage with nonsteroidal anti-inflammatory drug use after tonsillectomy: a meta-analysis. Arch Otolaryngol Neck Surg 2003;129:1086–9CrossRefGoogle ScholarPubMed
Møiniche, S, Rømsing, J, Dahl, JB, Tramer, MR. Nonsteroidal antiinflammatory drugs and the risk of operative site bleeding after tonsillectomy: a quantitative systematic review. Anesth Analg 2003;96:68–77CrossRefGoogle ScholarPubMed
Chan, CC, Chan, YY, Tanweer, F. Systematic review and meta-analysis of the use of tranexamic acid in tonsillectomy. Eur Arch Otorhinolaryngol 2013;270:735–48CrossRefGoogle ScholarPubMed
National Institute for Health and Care Excellence. Routine preoperative tests for elective surgery. In: https://www.nice.org.uk/guidance/ng45/chapter/Recommendations [14 September 2020]Google Scholar
Windfuhr, JP, Chen, Y-S, Remmert, S. Unidentified coagulation disorders in post-tonsillectomy hemorrhage. Ear Nose Throat J 2004;83:28–39CrossRefGoogle ScholarPubMed