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Bleeding after tonsillectomy in severe von Willebrand's disease

Published online by Cambridge University Press:  29 June 2007

G. H. Alusi ,
W. E. Grant ,
C. A. Lee ,
K. J. Pasi  and
M. P. Stearns
G. H. Alusi*
Affiliation:
Department of Otolaryngology, Head and Neck Surgery, and the Haemophilia Centre and Haemostasis Unit, Royal Free Hospital, School of Medicine. Pond Street, London NW3 2QG.
W. E. Grant
Affiliation:
Department of Otolaryngology, Head and Neck Surgery, and the Haemophilia Centre and Haemostasis Unit, Royal Free Hospital, School of Medicine. Pond Street, London NW3 2QG.
C. A. Lee
Affiliation:
Department of Haematologyt, Royal Free Hospital, School of Medicine. Pond Street, London NW3 2QG.
K. J. Pasi
Affiliation:
Department of Haematologyt, Royal Free Hospital, School of Medicine. Pond Street, London NW3 2QG.
M. P. Stearns
Affiliation:
Department of Otolaryngology, Head and Neck Surgery, and the Haemophilia Centre and Haemostasis Unit, Royal Free Hospital, School of Medicine. Pond Street, London NW3 2QG.
*
Address for correspondence: Mr G. H. Alusi, F.R.C.S., Department of Otolaryngology, Head and Neck Surgery, Royal Free Hospital. Pond Street, London NW3 2QG.
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Abstract

A case is reported of a HIV–positive patient with severe von Willebrand's disease describing the bleeding complications during and after tonsillectomy. This patient underwent surgery for asymmetrical tonsillar hypertrophy. The tonsils were spontaneously haemorrhaging and there therefore was a suspicion of neoplasia. Despite close cooperation between the ENT Department and the Haemophilia Centre, involving per–operative Factor VIII monitoring and replacement, the patient suffered both protracted primary and secondary haemorrhages. We report this as a cautionary tale as our previous experience with mild to moderate haemophilia has been uncomplicated, but on this occcasion there was massive haemorrhage. We feel that tonsillectomy should not be undertaken in a patient with a severe bleeding disorder without an absolute indicate.

Keywords

TonsillectomyHaemorrhagevon Willebrand's diseaseHIV
Type
Clinical Records
Information
The Journal of Laryngology & Otology , Volume 109 , Issue 5 , May 1995 , pp. 437 - 439
Copyright
Copyright © JLO (1984) Limited 1995

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References

Castillo, R., Monteagudo, J., Escolar, G., Ordinas, A., Magall'on, M., Villar, J. M. (1991) Hemostatic effect of normal platelet transfusion in severe von Willebrand disease patients. Btood 77: 1991–1995.Google ScholarPubMed
Khair, K.Spence, K.Majumdar, G., Savidge, G. F. (1994) Continuous infusion therapy of very high purity von Willebrand Factor concentrate (VWF–VHP) in patients with severe (type III) von Willebrand's disease. XXI Internationat Conference, World Federation of Haemophilia, p 198.Google Scholar
Kitchens, S. C. (1986) Surgery in haemophilia and related disorders. Medicine 65: 34–35.CrossRefGoogle ScholarPubMed
Lane, H. C., Masur, H., Edgar, L. C., Whaler, G., Rook, A. M., Fauci, A. S. (1983) Abnormalities of B-cell activation and immunoregulation in patients with the acquired immunodeficiency syndrome.New Engtand Journat of Medicine 309: 453–458.CrossRefGoogle ScholarPubMed
Mannucci, P. M., Tenconi, P. M., Castaman, O., Rodeghiero, F (1992) Comparison of four virus-inactivated plasma concentrates for treatment of severe von Willebrand disease: a cross-over randomized trial. Btood 79: 3130–3137.Google ScholarPubMed
Pasi, K. J., Williams, M. D.Enayat, M. S., Hill, F G. H. (1990) Clinical and laboratory evaluation of von Willebrand's disease patients with heat-treated Factor VIII concentrate (BPL 8Y). British Journal of Haematotogy 75: 228–233.CrossRefGoogle ScholarPubMed
Prinsley, P., Wood, M., Lee, C. A. (1993) Adenotonsillectomy in patients with inherited bleeding disorders. Ctinicat Ototaryngology 18: 206–208.Google ScholarPubMed
Scott, J. P., Montgomery, R. R. (1993) Therapy of von Willebrand's disease. Seminars in Thrombosis and Hemostasis 19: 37–47.CrossRefGoogle Scholar
UK Regional Haemophilia Centre Directors Committee (1992) Recommendations of choice of therapeutic products for the treatment of patients with haemophilia A, haemophilia B and von Willebrand's disease. Blood Coagulation and Fibrinolysis 3: 205–214.CrossRefGoogle Scholar