NEW YORK (Reuters Health) - US researchers have created a treatment protocol that can make tonsillectomy a safe undertaking for children with bleeding disorders, according to findings presented at the annual meeting of the Triological Society in Phoenix, Arizona. The strategy reduces blood loss to less than that usually seen with unaffected children.
Otolaryngologists “are typically reluctant to perform adenotonsillectomy on children with bleeding disorders,” senior author Dr. Charles Gross, from the University of Virginia in Charlottesville, told Reuters Health. “The protocol we’ve developed appears to be a simple and effective method” for reducing their bleeding risk, making them candidates for such surgery.
The study included six children with mild type 1 von Willebrand disease (VWD), three with Factor VIII deficiency, and one with platelet dysfunction. With the exception of one VWD patient who underwent tonsillectomy alone, all of the patients underwent adenotonsillectomy.
The treatment protocol for VWD patients included documenting an adequate Ristocetin/Factor VIII response to DDAVP before surgery and then using the agent at set points in the perioperative period. Humate was recommended if the response to DDAVP was inadequate. Aminocaproic acid was also given for several days after surgery.
For patients with Factor VIII deficiency, infusions of the factor were started just prior to surgery, continued intraoperatively, and then given for up to 8 days after surgery.
Average intraoperative blood loss was just 37.5 cc -- actually less than the amount typically seen in healthy children undergoing adenotonsillectomy, Dr. Gross noted. Moreover, no postoperative bleeding complications occurred in any of the children.
The average hospital stay for VWD patients was 23 hours, while the average for patients with Factor VIII deficiency was 4.3 days.
“This is really just a proof of concept study but we were so encouraged by the findings that we wanted to advise our fellow otolaryngologists about this protocol,” Dr. Gross said. “I think most surgeons will be receptive to the protocol, but I would recommend that it be implemented with the assistance of pediatric hematologist.”
MeSH Headings:Intraoperative Complications: Pathologic Processes: Pathological Conditions, Signs and Symptoms: Blood Loss, Surgical: DiseasesCopyright © 2002 Reuters Limited. All rights reserved. Republication or redistribution of Reuters content, including by framing or similar means, is expressly prohibited without the prior written consent of Reuters. Reuters shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon. Reuters and the Reuters sphere logo are registered trademarks and trademarks of the Reuters group of companies around the world.
