title: Occurrence of coagulation factor deficiency in post-tonsillectomy hemorrhage.
abstract: BACKGROUND
  Tonsillectomy is one of the most common surgical procedures in Otorhinolaryngology and approximately 500 tonsillectomies are performed annually at the University Hospital of Vienna. Substantial postoperative bleeding is observed in 1.8% of cases, which is comparable to frequencies of 2-4% reported in other studies. Currently, routine pre-surgical coagulation investigations to predict bleeding status do not include the analysis of individual coagulation factors.
  
  
  METHODS
  Within 2007 complete coagulation diagnostics were carried out in three patients presenting with recurrent (2-7 times) post-tonsillectomy hemorrhage but normal pre-surgical coagulation status parameters.
  
  
  RESULTS
  After the appearance of recurrent late bleeding, single factor diagnostic analysis revealed the causes to be factor XIIa deficiency, reduced factor XIIIa or von Willebrand disease. Recurrent late bleeding was stopped by the application of coagulation active plasma.
  
  
  CONCLUSIONS
  This study shows that, even if routine diagnostics show normal pre-surgical coagulation findings, the investigation of single factors in cases of post-surgical late bleeding may identify coagulation disorders allowing the application of tailored therapy. Including such analysis in pre-operative diagnostics could therefore significantly help to limit postoperative bleeding.
authors.affiliation: Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Austria.
authors.forename: Michaela
authors.initials: M
authors.lastname: Zumtobel
authors.forename: Klemens
authors.initials: K
authors.lastname: Frei
mesh_terms: D000328:Adult; D001778:Blood Coagulation Disorders / Q000097:blood* / Q000209:etiology; D001779:Blood Coagulation Factors / Q000032:analysis*; D005260:Female; D006470:Hemorrhage / Q000097:blood* / Q000209:etiology*; D006801:Humans; D008297:Male; D014068:Tonsillectomy / Q000009:adverse effects*
chemical_list: D001779:Blood Coagulation Factors