Open AccessPredictors of Bleeding Disorders in Children with Epistaxis: Value of Preoperative Tests and Clinical Screening
Author(s) -
Elden Lisa M.,
Reinders Megan,
Witmer Char
Publication year - 2011
Publication title -
otolaryngology–head and neck surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.232
H-Index - 121
eISSN - 1097-6817
pISSN - 0194-5998
DOI - 10.1177/0194599811415823a355
Subject(s) - medicine , von willebrand disease , otorhinolaryngology , coagulopathy , pediatrics , retrospective cohort study , surgery , family history , medical history , von willebrand factor , platelet
Objective Children with recurrent epistaxis despite medical therapy may be at higher risk of having a bleeding disorder. The objective of this study was to identify the prevalence of previously undiagnosed bleeding disorders in children with severe epistaxis who failed medical therapy requiring intraoperative nasal cautery. Method Retrospective chart review from October 15, 2006 to December 31, 2010. Inclusion criteria: children (<19 years) with epistaxis referred to otolaryngology, no known bleeding disorder, and failed medical therapy requiring nasal cautery. Data collected: duration and severity of epistaxis, bleeding history, family history of bleeding. Screening CBC, PT and PTT were performed on all of patients. Results Of 248 subjects referred for epistaxis, 47 met study inclusion criteria (mean age 8.6 ± 3.8 years; male:female ratio 29:18). Coagulation studies revealed 12.8% (6/47) prolonged PT, 8.5% (4 /47) prolonged PTT, 10.6% (5/47) prolonged PT and PTT. Three with borderline levels proceeded to surgery. Twelve were referred to hematology secondary to abnormal coagulation studies. Of these, five patients (5/12, 42%) were diagnosed with a bleeding disorder (3‐type 1 von Willebrand’s disease (VWD), 1‐platelet aggregation disorder, and 1‐factor VII deficiency). Overall, 6.4% (3/47) had VWD in this cohort, which is higher than the reported prevalence of 1%. Conclusion Knowledge of whether a child has a coagulopathy prior to surgery can limit complications. In this highly selected group of patients with persistent epistaxis, 10.6% (5/47) had a bleeding disorder. It is important to consider hemostatic testing in high risk patients.