Re: Effect of systemic steroids on post-tonsillectomy bleeding and reinterventions: systematic review and meta-analysis of randomised controlled trials
30 August 2012
Post Tonsillectomy bleeding has the potential for catastrophic consequences. As such, it is right that much effort goes into devising strategies to minimise this occurrence.
What is rarely considered in preventing unintended excessive bleeding is the consideration that a patient might have an underlying bleeding disorder. This is surprising, as the incidence of Von Willebrands disease is 1 in 50.
In the assessment of someone’s risk of postoperative bleeding, it doesn’t take much trouble to take a bleeding history. That way, patients at high risk can be identified pre operatively and managed appropriately intraoperativley. For example, with the concurrent use of desmopressin, clotting factors and cyclokapron.
It would be a feather in the cap to ENT surgeons were they to pilot this – After all, up to 25% of women having a hysterectomy for heavy menstrual bleeding with a normal sized uterus have Von Willebrands disease. Yet gynaecologists rarely, if ever, take this into consideration when preparing to undertake major surgical procedures upon women.
Competing interests: None declared
Royal Oldham Hospital, Rochdale Road, Oldham, Lancs, OL1 2JH
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