Final Diagnosis of Pediatric Patients with Prolonged in Activated Partial Thromboplastin Time Preoperative Study
Affiliation(s)
1 Pediatrics Resident, Pontifical Catholic University of Chile, Santiago, Chile. 2 School of Medicine, Pontifical Catholic University of Chile, Santiago, Chile. 3 Pediatrician, Resident of Pediatric Gastroenterology and Nutrition, Pontifical Catholic University of Chile, Santiago, Chile. 4 Otorhinolaryngologist, Assistant Professor, Pediatrics Division, Medical School, Pontifical Catholic University of Chile, Santiago, Chile. 5 Hematologist-Oncologist, Assistant Professor, Pediatrics Division, Medical School, Pontifical Catholic University of Chile, Santiago, Chile.
1 Pediatrics Resident, Pontifical Catholic University of Chile, Santiago, Chile. 2 School of Medicine, Pontifical Catholic University of Chile, Santiago, Chile. 3 Pediatrician, Resident of Pediatric Gastroenterology and Nutrition, Pontifical Catholic University of Chile, Santiago, Chile. 4 Otorhinolaryngologist, Assistant Professor, Pediatrics Division, Medical School, Pontifical Catholic University of Chile, Santiago, Chile. 5 Hematologist-Oncologist, Assistant Professor, Pediatrics Division, Medical School, Pontifical Catholic University of Chile, Santiago, Chile.
ABSTRACT
Introduction: Activated partial thromboplastin time (aPTT) is one of the most used coagulation tests in preoperative evaluation. Incidental detection of a prolonged aPTT is a problem in primary care, in which the general pediatrician should be able to attend its initial management. Objective: To describe final diagnosis of patients with prolonged aPTT in preoperative study. Materials and Methods: This is a descriptive study of patients referred from otorhinolaryngology. Results: Totally, 508 adenoidectomies and/or tonsillectomies were performed in our center, 38 of which referred patients (7.5%) with prolonged aPTT, and 30 of which met inclusion criteria. The median age was 4 years. 56.6% of patients were males. 76.6% of patients normalized aPTT at the second follow-up. Among these, 73.9% showed a normal study, 4.3% ha2d lupus anticoagulant and in 21.7% Von Willebrand disease was detected. Among patients that persisted with prolonged aPTT, 42.8% had coagulant factors deficiency, 28.5% had lupus anticoagulant and in 28.5% of patients a diagnosis could not be achieved with the tests used in the present study. Multivariate analysis did not show correlation between final diagnosis and the variables measured. Conclusion: The presence of a prolonged aPTT in children under preoperative study is due to a pre-analytic factor in the majority of cases or to the presence of lupus anticoagulant, normalizing values on follow-up. We suggest that a new aPTT be performed on these patients, and only those that persist altered or present a symptoms and family history of coagulation disorders be referred to hematology.
Introduction: Activated partial thromboplastin time (aPTT) is one of the most used coagulation tests in preoperative evaluation. Incidental detection of a prolonged aPTT is a problem in primary care, in which the general pediatrician should be able to attend its initial management. Objective: To describe final diagnosis of patients with prolonged aPTT in preoperative study. Materials and Methods: This is a descriptive study of patients referred from otorhinolaryngology. Results: Totally, 508 adenoidectomies and/or tonsillectomies were performed in our center, 38 of which referred patients (7.5%) with prolonged aPTT, and 30 of which met inclusion criteria. The median age was 4 years. 56.6% of patients were males. 76.6% of patients normalized aPTT at the second follow-up. Among these, 73.9% showed a normal study, 4.3% ha2d lupus anticoagulant and in 21.7% Von Willebrand disease was detected. Among patients that persisted with prolonged aPTT, 42.8% had coagulant factors deficiency, 28.5% had lupus anticoagulant and in 28.5% of patients a diagnosis could not be achieved with the tests used in the present study. Multivariate analysis did not show correlation between final diagnosis and the variables measured. Conclusion: The presence of a prolonged aPTT in children under preoperative study is due to a pre-analytic factor in the majority of cases or to the presence of lupus anticoagulant, normalizing values on follow-up. We suggest that a new aPTT be performed on these patients, and only those that persist altered or present a symptoms and family history of coagulation disorders be referred to hematology.
Cite this paper
Aguirre, N. , Córdova, F. , Jaime, F. , Fonseca, X. and Zúñiga, P. (2015) Final Diagnosis of Pediatric Patients with Prolonged in Activated Partial Thromboplastin Time Preoperative Study. International Journal of Otolaryngology and Head & Neck Surgery, 4, 241-247. doi: 10.4236/ijohns.2015.43041.
Aguirre, N. , Córdova, F. , Jaime, F. , Fonseca, X. and Zúñiga, P. (2015) Final Diagnosis of Pediatric Patients with Prolonged in Activated Partial Thromboplastin Time Preoperative Study. International Journal of Otolaryngology and Head & Neck Surgery, 4, 241-247. doi: 10.4236/ijohns.2015.43041.
References
[1] Anjali, A. and Steven, W. (2008) Bleeding Disorders. Pediatrics in Review, 29, 121-130.
http://dx.doi.org/10.1542/pir.29-4-121 [2] Shah, M., O’Riordan, M. and Alexander, S. (2006) Evaluation of Prolonged aPTT Values in the Pediatric Population. Clinical Pediatrics, 45, 347-353.
http://dx.doi.org/10.1177/000992280604500407 [3] Edlinger, G., Gallistl, S. and Muntean, W. (1996) Lupus Anticoagulant and Factor XII Activity in Children with Prolonged PTT. Thrombosis Research, 83, 403-404.
http://dx.doi.org/10.1016/0049-3848(96)00150-8 [4] Katrin, F., Karl, L. and Philipp, V. (2005) Antiphospholipid Antibodies in Pediatric Patients with Prolonged Activated Partial Thromboplastin Time during Infection. Immunobiology, 210, 799-805.
http://dx.doi.org/10.1016/j.imbio.2005.10.012 [5] Shiomou, K., Galanakis, E., Tzoufi, M., Tsaousi, C. and Papadopoulou, Z.L. (2002) Transient Lupus Anticoagulant and Prolonged Activated Partial Thromboplastin Time Secondary to Epstein-Barr Virus Infection. Scandinavian Journal of Infectious Diseases, 34, 67-69.
http://dx.doi.org/10.1080/003655402753395229 [6] Mizumoto, H., Maihara, T., Hiejima, E., Shiota, M., Hata, A., Seto, S., Atsumi, T., Koike, T. and Hata, D. (2006) Transient Antiphospholipid Antibodies Associated with Acute Infections in Children: A Report of Three Cases and a Review of the Literature. European Journal of Pediatrics, 165, 484-488.
http://dx.doi.org/10.1007/s00431-006-0117-0 [7] Blank, M., Krause, I., Fridkin, M., Keller, N., Kopolovic, J., Goldberg, I., Tobar, N. and Shoenfeld, Y. (2002) Bacterial Induction of Autoantibodies to Be-ta2-Glycoprotein-I Accounts for the Infectious Etiology of Antiphospholipid Syndrome. The Journal of Clinical Investigation, 109, 797-804.
http://dx.doi.org/10.1172/JCI0212337 [8] Bermejo, A., Gonzalez, H., Abad, A., Figueroa, L., Munoz, R., Marcos, M., Cebeira, M.J. and Alvarez, F.J. (2013) Anticoagulante lúpico en pediatria. Experiencia en nuestro centro. Boletín de la sociedad de pediatría de asturias, cantabria, castilla y león, 53, 146-151. [9] Lippi, G., Salvagno, G.L., Rugolotto, S., Chiaffoni, G.P., Padovani, E.M., Franchini, M. and Guidi, G.C. (2007) Routine Coagulation Tests in Newborn and Young Infants. Journal of Thrombosis and Thrombolysis, 24, 153-155.
http://dx.doi.org/10.1007/s11239-007-0046-4 [10] Hoyos López, M.C., Pascual Pérez, J.M., Blanco Quirós, A., Guerola Delgado, D., Valbuena Crespo, C. and álvarez Guisasola, G. (1999) Anticoagulante lúpico en pediatria. Presentación de 4 casos. Anales Espanoles de Pediatria, 51, 637-642. [11] Marioni, G. and de Filippi, C. (2009) Pediatric Otolaryngologic Manifestations of Bleeding Disorders. International Journal of Pediatric Otorhinolaryngology, 735, S61-S64.
http://dx.doi.org/10.1016/S0165-5876(09)70012-6 [12] Chng, W.J., Sum, C. and Kuperan, P. (2005) Causes of Isolated Prolonged Activated Partial Thromboplastin Time in an Acute Care General Hospital. Singapore Medical Journal, 46, 450-246. [13] Gabriel, P., Mazoit, X. and Ecoffey, C. (2000) Relationship between Clinical History, Coagulation Tests, and Perioperative Bleeding during Tonsillectomies in Pediatrics. Journal of Clinical Anesthesia, 12, 288-291.
http://dx.doi.org/10.1016/S0952-8180(00)00164-1 [14] Sandoval, C., Garcia, C., Visintainer, P., Ozkaynak, M.F. and Jayabose, S. (2003) The Usefulness of Preoperative Screening for Bleeding Disorders. Clinical Pediatrics, 42, 247-250.
http://dx.doi.org/10.1177/000992280304200308 [15] Asaf, T., Reuveni, H., Yermiahu, T., Leiberman, A., Gurman, G., Porat, A., Schlaeffer, P., Shifra, S. and Kapelushnik, J. (2001) The Need for Routine Pre-Operative Coagulation Screening Tests (Prothrombin Time PT/Partial Thromboplastin Time PTT) for Healthy Children Undergoing Elective Tonsillectomy and/or Adenoidectomy International. International Journal of Pediatric Otorhinolaryngology, 61, 217-222.
http://dx.doi.org/10.1016/S0165-5876(01)00574-2 [16] Rodeghiero, F., Castaman, G., Tosetto, A., Batlle, J., Baudo, F., Cappelletti, A., Casana, P., de Bosch, N., Eikenboom, J.C., Federici, A.B., Lethagen, S., Linari, S. and Srivastava, A. (2005) The Discriminant Power of Bleeding History for the Diagnosis of von Willebrand Disease Type 1: An Interntional, Multicenter Study. Journal of Thrombosis and Haemostasis, 3, 2619-2626.
http://dx.doi.org/10.1111/j.1538-7836.2005.01663.x [17] Windfuhr, J.P. and Chen, Y.S. (2002) Incidence of Post-Tonsillectomy Hemorrhage in Children and Adults: A Study of 4848 Patients. Ear, Nose & Throat Journal, 81, 626-628. [18] Zagólski, O. (2010) Hemorragia postamigdalectomía: tienen las pruebas de coagulación y el historial de coagulopatía un valor predictivo? Acta Otorrinolaringológica Espanola, 61, 287-292.
http://dx.doi.org/10.1016/j.otorri.2010.01.017 [19] Koshkareva, Y.A., Cohen, M., Gaughan, J.P., Callanan, V. and Szeremeta, W. (2012) Utility of Preoperative Hematologic Screening for Pediatric Adenotonsillectomy. Ear, Nose Throat Journal, 91, 346-356. [20] Li, J., Lai, X., Yan, C., Xu, A., Nie, L., Zhou, Y., Liao, C. and Ren, H. (2009) Age-Associated Developmental Changes in the Activated Partial Thromboplastin Time (aPTT) and Causes of Prolonged aPTT Values in Healthy Chinese Children. Clinical Chemistry and Laboratory Medicine, 47, 1531-1537.
http://dx.doi.org/10.1515/CCLM.2009.339 [21] Burk, C.D., Miller, L., Handler, S.D. and Cohen, A.R. (1992) Preoperative History and Coagulation Screening in Children Undergoing Tonsillectomy. Pediatrics, 89, 691-695.
http://dx.doi.org/10.1097/00132586-199212000-00035 [22] Genecov, D.G., Por, Y.C., Barcelo, C.R., Salyer, K.E., Mulne, A.F. and Morad, A.B. (2005) Preoperative Screening for Coagulopathy Using Prothrombin Time and Partial Thromboplastin Time in Patients Requiring Primary Cranial Vault. Plastic and Reconstructive Surgery, 116, 389-394.
http://dx.doi.org/10.1097/01.prs.0000172760.79803.68
[1] Anjali, A. and Steven, W. (2008) Bleeding Disorders. Pediatrics in Review, 29, 121-130.
http://dx.doi.org/10.1542/pir.29-4-121 [2] Shah, M., O’Riordan, M. and Alexander, S. (2006) Evaluation of Prolonged aPTT Values in the Pediatric Population. Clinical Pediatrics, 45, 347-353.
http://dx.doi.org/10.1177/000992280604500407 [3] Edlinger, G., Gallistl, S. and Muntean, W. (1996) Lupus Anticoagulant and Factor XII Activity in Children with Prolonged PTT. Thrombosis Research, 83, 403-404.
http://dx.doi.org/10.1016/0049-3848(96)00150-8 [4] Katrin, F., Karl, L. and Philipp, V. (2005) Antiphospholipid Antibodies in Pediatric Patients with Prolonged Activated Partial Thromboplastin Time during Infection. Immunobiology, 210, 799-805.
http://dx.doi.org/10.1016/j.imbio.2005.10.012 [5] Shiomou, K., Galanakis, E., Tzoufi, M., Tsaousi, C. and Papadopoulou, Z.L. (2002) Transient Lupus Anticoagulant and Prolonged Activated Partial Thromboplastin Time Secondary to Epstein-Barr Virus Infection. Scandinavian Journal of Infectious Diseases, 34, 67-69.
http://dx.doi.org/10.1080/003655402753395229 [6] Mizumoto, H., Maihara, T., Hiejima, E., Shiota, M., Hata, A., Seto, S., Atsumi, T., Koike, T. and Hata, D. (2006) Transient Antiphospholipid Antibodies Associated with Acute Infections in Children: A Report of Three Cases and a Review of the Literature. European Journal of Pediatrics, 165, 484-488.
http://dx.doi.org/10.1007/s00431-006-0117-0 [7] Blank, M., Krause, I., Fridkin, M., Keller, N., Kopolovic, J., Goldberg, I., Tobar, N. and Shoenfeld, Y. (2002) Bacterial Induction of Autoantibodies to Be-ta2-Glycoprotein-I Accounts for the Infectious Etiology of Antiphospholipid Syndrome. The Journal of Clinical Investigation, 109, 797-804.
http://dx.doi.org/10.1172/JCI0212337 [8] Bermejo, A., Gonzalez, H., Abad, A., Figueroa, L., Munoz, R., Marcos, M., Cebeira, M.J. and Alvarez, F.J. (2013) Anticoagulante lúpico en pediatria. Experiencia en nuestro centro. Boletín de la sociedad de pediatría de asturias, cantabria, castilla y león, 53, 146-151. [9] Lippi, G., Salvagno, G.L., Rugolotto, S., Chiaffoni, G.P., Padovani, E.M., Franchini, M. and Guidi, G.C. (2007) Routine Coagulation Tests in Newborn and Young Infants. Journal of Thrombosis and Thrombolysis, 24, 153-155.
http://dx.doi.org/10.1007/s11239-007-0046-4 [10] Hoyos López, M.C., Pascual Pérez, J.M., Blanco Quirós, A., Guerola Delgado, D., Valbuena Crespo, C. and álvarez Guisasola, G. (1999) Anticoagulante lúpico en pediatria. Presentación de 4 casos. Anales Espanoles de Pediatria, 51, 637-642. [11] Marioni, G. and de Filippi, C. (2009) Pediatric Otolaryngologic Manifestations of Bleeding Disorders. International Journal of Pediatric Otorhinolaryngology, 735, S61-S64.
http://dx.doi.org/10.1016/S0165-5876(09)70012-6 [12] Chng, W.J., Sum, C. and Kuperan, P. (2005) Causes of Isolated Prolonged Activated Partial Thromboplastin Time in an Acute Care General Hospital. Singapore Medical Journal, 46, 450-246. [13] Gabriel, P., Mazoit, X. and Ecoffey, C. (2000) Relationship between Clinical History, Coagulation Tests, and Perioperative Bleeding during Tonsillectomies in Pediatrics. Journal of Clinical Anesthesia, 12, 288-291.
http://dx.doi.org/10.1016/S0952-8180(00)00164-1 [14] Sandoval, C., Garcia, C., Visintainer, P., Ozkaynak, M.F. and Jayabose, S. (2003) The Usefulness of Preoperative Screening for Bleeding Disorders. Clinical Pediatrics, 42, 247-250.
http://dx.doi.org/10.1177/000992280304200308 [15] Asaf, T., Reuveni, H., Yermiahu, T., Leiberman, A., Gurman, G., Porat, A., Schlaeffer, P., Shifra, S. and Kapelushnik, J. (2001) The Need for Routine Pre-Operative Coagulation Screening Tests (Prothrombin Time PT/Partial Thromboplastin Time PTT) for Healthy Children Undergoing Elective Tonsillectomy and/or Adenoidectomy International. International Journal of Pediatric Otorhinolaryngology, 61, 217-222.
http://dx.doi.org/10.1016/S0165-5876(01)00574-2 [16] Rodeghiero, F., Castaman, G., Tosetto, A., Batlle, J., Baudo, F., Cappelletti, A., Casana, P., de Bosch, N., Eikenboom, J.C., Federici, A.B., Lethagen, S., Linari, S. and Srivastava, A. (2005) The Discriminant Power of Bleeding History for the Diagnosis of von Willebrand Disease Type 1: An Interntional, Multicenter Study. Journal of Thrombosis and Haemostasis, 3, 2619-2626.
http://dx.doi.org/10.1111/j.1538-7836.2005.01663.x [17] Windfuhr, J.P. and Chen, Y.S. (2002) Incidence of Post-Tonsillectomy Hemorrhage in Children and Adults: A Study of 4848 Patients. Ear, Nose & Throat Journal, 81, 626-628. [18] Zagólski, O. (2010) Hemorragia postamigdalectomía: tienen las pruebas de coagulación y el historial de coagulopatía un valor predictivo? Acta Otorrinolaringológica Espanola, 61, 287-292.
http://dx.doi.org/10.1016/j.otorri.2010.01.017 [19] Koshkareva, Y.A., Cohen, M., Gaughan, J.P., Callanan, V. and Szeremeta, W. (2012) Utility of Preoperative Hematologic Screening for Pediatric Adenotonsillectomy. Ear, Nose Throat Journal, 91, 346-356. [20] Li, J., Lai, X., Yan, C., Xu, A., Nie, L., Zhou, Y., Liao, C. and Ren, H. (2009) Age-Associated Developmental Changes in the Activated Partial Thromboplastin Time (aPTT) and Causes of Prolonged aPTT Values in Healthy Chinese Children. Clinical Chemistry and Laboratory Medicine, 47, 1531-1537.
http://dx.doi.org/10.1515/CCLM.2009.339 [21] Burk, C.D., Miller, L., Handler, S.D. and Cohen, A.R. (1992) Preoperative History and Coagulation Screening in Children Undergoing Tonsillectomy. Pediatrics, 89, 691-695.
http://dx.doi.org/10.1097/00132586-199212000-00035 [22] Genecov, D.G., Por, Y.C., Barcelo, C.R., Salyer, K.E., Mulne, A.F. and Morad, A.B. (2005) Preoperative Screening for Coagulopathy Using Prothrombin Time and Partial Thromboplastin Time in Patients Requiring Primary Cranial Vault. Plastic and Reconstructive Surgery, 116, 389-394.
http://dx.doi.org/10.1097/01.prs.0000172760.79803.68