(A234) Post-Tonsillectomy Bleeding in a Patient with Crohn's Disease: Evaluating the Role of Coagulation Testing

Introduction: The effect of Crohn’s disease on the clotting cascade is multifaceted. Increased platelet activity may contribute to a prothrombotic state, while malabsorption from intestinal inflammation may lead to deficiencies of nutrients which are critical for clotting factor activation, such as vitamin K. A patient’s bleeding risk depends on this unique interplay of hemostatic factors and is influenced by medication use and nutritional status.

Methods: We report a case of a 17-year-old male with Crohn's disease who experienced postoperative bleeding following tonsillectomy and adenoidectomy, believed to be secondary to coagulopathy due to vitamin K deficiency associated with malabsorption.

Results: A 17-year-old boy with a history of Crohn's disease, OSA, and recurrent tonsillitis underwent uncomplicated tonsillectomy with monopolar cautery and adenoidectomy. Biologic therapy, infliximab-dyyb, for Crohn’s was held 1 month prior to surgery. Hemostasis was achieved with suction cautery and the patient was discharged from PACU without significant event. On post operative day 4, the patient vomited up large volumes of clot. In the ED, he received a bolus of fluid, nebulized TXA, and lab workup including CBC, type and screen, PT/INR, and PTT. The patient was brought to the OR and bleeding from the right tonsillar fossa was identified and controlled with suction cautery. He was noted to have elevated PT/INR of 14.9/1.31. Hematology suggested Vitamin K malabsorption in the setting of Crohn's disease may have contributed to impair clotting. A dose of vitamin K was given, and the patient was observed overnight without further episodes of bleeding and subsequently discharged.

Conclusions: Crohn’s disease can impact hemostasis. Existing guidelines for the perioperative management of patients with IBD do not specify the routine checking of coagulation profiles. Given the potential for bleeding events and the feasibility of testing, checking coagulation profiles in collaboration with primary care, hematology, or gastroenterology should be considered in this patient population.