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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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