The incidence of venous thromboembolism (VTE ) during childhood is low with two peaks – neonatal and adolescent age. This retrospective study is focused on clinical characteristics of VTE during adolescence. The main goals are to assess the most frequent inherited and acquired risk factors and to evaluate the benefit of D-dimers in diagnostics of venous thromboemblism. The data of 18 adolescents were analysed – 16 girls (88.9%), 2 boys (11.1%). In 9 patients (50%) thrombosis of the lower limb deep veins was diagnosed, six patients (33.3%) suffered from symptomatic pulmonary embolism (PE ) and 3 patients (16.7%) from thrombosis at unusual sites. One patient had an idiopathic VTE , the mean number of the inherited and acquired risk factors was 2.6. The most frequent inherited risk factor was Leiden mutation of factor V (27.8%). The most frequent acquired risk factor was oral contraception (OC ) in 12 out of 16 girls (75%). All of our patients on oral contraception had one or more additional risk factors. 10 out of 18 (55.6%) patients with VTE had elevated activity of factor VIII . The sensitivit
- MeSH
- beta Carotene analogs & derivatives MeSH
- Factor V genetics MeSH
- Humans MeSH
- Adolescent MeSH
- Pulmonary Embolism diagnosis etiology genetics MeSH
- Risk Factors MeSH
- Thrombophilia complications MeSH
- Venous Thromboembolism diagnosis etiology genetics MeSH
- Check Tag
- Humans MeSH
- Adolescent MeSH
- Male MeSH
- Female MeSH
To prevent bleeding related to adenoidectomy and tonsillectomy, coagulation screening tests were, until recently, performed routinely in the Czech Republic for all paediatric patients. The aim of this study was to evaluate benefit of preoperative coagulation screening tests in children. We retrospectively analysed laboratory and clinical data of children referred for abnormal preoperative coagulation test results (aPTT, PT) to the outpatient haematology clinic. A total of 274 paediatric patients were retrospectively evaluated due to abnormal preoperative coagulation tests results. In 140 of 274 patients (51.1%), coagulation tests were normal on repeated testing in a specialized haematology clinic. Ten patients had decreased factor XII. Five patients had a suspected bleeding disorder which was confirmed in two of them. One patient had low levels of von Willebrand factor, and one patient had mild factor VII deficiency. Both these patients had positive personal and/or family history of bleeding. Each case history was taken individually, without use of standardized questionnaires. Bleeding complications were not observed, and coagulation factor replacement was not needed perioperatively in our cohort. The majority of abnormal findings in aPTT and PT appeared only transiently. All the bleeding disorders found in our cohort of patients were mild in nature. Our findings provide supportive evidence for the current national Czech recommendation: laboratory coagulation screening should be performed only in patients with positive family and/or personal bleeding history.
- MeSH
- Adenoidectomy adverse effects MeSH
- Child MeSH
- Blood Coagulation Factors analysis MeSH
- Blood Coagulation Disorders diagnosis MeSH
- Cohort Studies MeSH
- Infant MeSH
- Humans MeSH
- Partial Thromboplastin Time methods MeSH
- Mass Screening methods MeSH
- Postoperative Hemorrhage prevention & control MeSH
- Predictive Value of Tests MeSH
- Preoperative Care methods MeSH
- Child, Preschool MeSH
- Prothrombin Time MeSH
- Retrospective Studies MeSH
- Tonsillectomy adverse effects MeSH
- Check Tag
- Child MeSH
- Infant MeSH
- Humans MeSH
- Male MeSH
- Child, Preschool MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Evaluation Study MeSH
- Geographicals
- Czech Republic MeSH
Úvod: V České republice se ve většině zdravotnických zařízení rutinně provádí před adenoidektomií a tonzilektomií laboratorní vyšetření hemostázy. Vzhledem k nízké specificitě koagulačních testů a nízké prevalenci klinicky významných poruch hemostázy je diskutován přínos tohoto postupu. Cílem naší práce je zjistit nejčastější příčiny prodloužení aPTT a PT (INR), přiblížit hemostazeologické poměry u těchto pacientů a sestavit vhodný anamnestický dotazník k odhalení poruch hemostázy. Soubor a metody: Prospektivně bylo vyšetřeno 106 dětí indikovaných k adenotomii nebo/ a tonzilektomii. Součástí předoperačního vyšetření byl dotazník zaměřený na krvácivou diatézu u dítěte a v rodině. Bylo provedeno laboratorní vyšetření: krevní obraz, krevní skupina, krvácivost dle Dukea, PT (INR), aPTT, aPTT citlivý na lupus anticoagulans (aPTT LA), dRVVT, D-dimery. V případě prodloužení aPTT nebo PT byla provedena doplňující vyšetření k určení příčiny. Výsledky: U 2 dětí byly zjištěny nezávažné krvácivé projevy. V rodinách dětí nebyla zjištěna krvácivá choroba a u blízkých příbuzných 4 pacientů byl údaj o nezávažných krvácivých projevech. 36 dětí mělo prodloužený aPTT dle věkově nespecifikovaného referenčního rozmezí, při porovnání s referenčním rozmezím dle věku byl aPTT prodloužený však jen u 6 dětí. PT byl prodloužen u 2 dětí. Příčinou prodloužení aPTT byl u 2 pacientů nespecifický inhibitor. U ostatních nebyl zjištěn deficit faktoru ani nebyly potvrzeny antifosfolipidové protilátky či jiný inhibitor. U žádného z dětí nevzniklo peri- či postoperačně závažné krvácení. Závěr: Prodloužení koagulačních testů je nejčastěji způsobeno klinicky nevýznamnými příčinami především nespecifickým inhibitorem. Hodnoty koagulačních testů je nutné porovnávat s referenčním rozmezím dle věku.
Introduction: In the most of hospitals in the Czech Republic is the routine laboratory screening of haemostasis performed before adenoidectomy and tonsillectomy. However, the benefit of this testing has been questioned, due to the very low predictive value and low prevalence of clinically relevant bleeding disorders. The aim of our study is to identify the most frequent causes of prolongation of aPTT and PT (INR), to outline the haemostatic background in these patients and to suggest suitable history questionnaire for revealing haemostasis disorders. Patients and methods: 106 paediatric patients before adenoidectomy or/ and tonsillectomy were prospectively examined. A part of the preoperative screening was a questionnaire focused on bleeding diathesis of the child and the family. Laboratory testing consisted of whole blood count, blood group, bleeding time (Duke), PT (INR), aPTT, aPTT with a higher sensitivity to lupus anticoagulans, dRVVT, and D-dimers. In case of prolongation of PT or aPTT further testing was done for identifying the cause. Results: Mild bleeding symptoms were found in the history of 2 children. No bleeding disorders were found in the patientęs families, however mild bleeding symptoms were found in the history of close relatives of 4 children. 36 children had prolonged aPTT according to age the unspecified reference range. When compared with reference range according to age, aPTT was prolonged in 6 children, while PT was prolonged in only 2. Unspecific inhibitor was found as the cause of prolonged aPTT in 2 patients. No bleeding disorder was detected in the rest of the patients. Any serious bleeding occurred peri- or postoperative among the children. Conclusion: Prolongation of coagulation tests is a common finding in routine pre-operative testing for adenoidectomy and tonsillectomy and is most frequently caused by clinically non-relevant reasons, especially unspecific inhibitor. It is necessary to compare the values of coagulation tests with the age specific reference range.
- Keywords
- adenotomie, anamnéza, krvácení, děti,
- MeSH
- Adenoidectomy methods trends MeSH
- Child MeSH
- Financing, Organized MeSH
- Hemorrhagic Disorders diagnosis complications prevention & control MeSH
- Humans MeSH
- Preoperative Care methods MeSH
- Tonsillectomy methods trends MeSH
- Blood Coagulation Tests standards utilization MeSH
- Check Tag
- Child MeSH
- Humans MeSH
Adenotomie (adenoidektomie) a tonzilektomie patří mezi nejčastější operace u dětí. Ve snaze najít pacienty se zvýšeným rizikem krvácivých komplikací během a po výkonu se ve většině pracovišť v České republice provádí plošné předoperační vyšetření hemostázy. Přínos tohoto vyšetření k predikci krvácivých komplikací byl zkoumán v mnoha zahraničních pracích. Opakovaně byla zjištěna velmi nízká predikce krvácení. Hlavním důvodem nízké predikce je skutečnost, že krvácení vzniká především z lokálních a chirurgických příčin. Pravděpodobnost diagnostikování dosud asymptomatické poruchy hemostázy je ovlivněna nízkou prevalencí klinicky významných poruch. Velký podíl falešně pozitivních výsledků aPTT v asymptomatické populaci způsobuje odkládání výkonů a nutnost podrobnějšího vyšetření k vyloučení poruchy hemostázy u těchto dětí. Vhodnějším přístupem je získání důkladné osobní i rodinné anamnézy krvácivé diatézy u všech dětí před operací formou standardizovaného dotazníku. U dětí s pozitivní anamnézou krvácivé diatézy nebo pokud nelze získat validní anamnézu, je indikováno laboratorní vyšetření hemostázy.
Adenoidectomy and tonsillectomy are two of the most frequent surgeries in children. In the most of Czech hospitals, screening tests to reveal possible impaired haemostasis and thus bleeding complications are routinely performed before such a surgery. The benefit of this screening has been however questioned in many studies worldwide. It has been demonstrated that the screening has very low ability to predict the bleeding complications. The reason for those findings is the fact, that most bleeding complications result from local and/or surgical conditions, rather than inherited coagulation disorders. The likelihood to identify a new patient with haemostatic disorder is influenced by the prevalence of clinically significant disorders, which is very low. Moreover, high incidence of falsely positive findings mainly in aPTT in asymptomatic population is causing significant delays in planning of those elective surgical procedures because it often leads to further detailed testing of haemostasis to rule out clinically significant bleeding disorder. We believe that thorough and careful personal and family history of bleeding tendency/disorder taken with the help of standardized questionnaire is more suitable tool for screening. The indication for laboratory haemostasis testing should be positive personal or family history of a bleeding tendency and/or an absence of a valid history at all.
- MeSH
- Adenoidectomy MeSH
- Diagnostic Tests, Routine MeSH
- Child MeSH
- Hemorrhagic Disorders diagnosis surgery prevention & control MeSH
- Hemostasis, Surgical MeSH
- Blood Coagulation Disorders diagnosis surgery prevention & control MeSH
- Blood Loss, Surgical MeSH
- Humans MeSH
- Preoperative Care MeSH
- Tonsillectomy MeSH
- von Willebrand Diseases MeSH
- Check Tag
- Child MeSH
- Humans MeSH
