Utility of Coagulation Studies and Hematology Consults in Post-tonsillectomy Hemorrhage

Introduction: Post-tonsillectomy hemorrhage is a serious complication after tonsillectomy that occurs at a rate between 0.2%-3%. The aim of this study was to determine the utility of coagulation lab studies and hematology consults for post-tonsillectomy hemorrhage.

Methods: A retrospective chart review was conducted on children who underwent operative control of post-tonsillectomy hemorrhage at a tertiary pediatric hospital from 2016-2024. Children without coagulation studies or with a pre-existing bleeding disorder were excluded. All demographic data and laboratory studies were collected.

Results: 22,262 children underwent tonsillectomy with 434 children (1.92%) requiring operative control of hemorrhage. 387 patients (89.2%) were included for analysis with 14 (3.62%) being diagnosed with a bleeding disorders including: von Willebrand disease (50%), platelet disorders (35.7%), Hemophilia A (7.1%), and factor deficiency (7.1%). Bleeding disorder diagnosis was significantly associated with need for multiple OR controls [p=0.009], administration of blood products [p=0.005], and abnormal PT or PTT [p=0.009]. Hematology consultation (n=116, 30%) did not yield any diagnosis during admission, but those evaluated were significantly more likely to receive tranexamic acid (TXA; 98.6% vs. 13.7%, p< 0.00001). Coagulation studies and hematology workup diagnosed 14 patients with a bleeding disorder, with an NNT of 28 for lab studies, 8 for inpatient consults, and 18 for clinic visits.

Conclusions: Our study is the largest to date evaluating a standardized protocol designed to identify bleeding disorders in children with post-tonsillectomy hemorrhage. Inpatient hematology evaluation demonstrated little benefit in diagnosing a bleeding disorder, with near universal TXA use. The NNT to identify children with a possibly dangerous bleeding disorder, was smaller than we had anticipated and can be further reduced with outpatient hematology evaluation. Further study is needed to adequately account for financial costs and individual patient benefit.