Significance of advanced haemostasis investigation in recurrent, severe post-tonsillectomy bleeding

Objective: To evaluate the significance of advanced post-operative haemostasis investigation in cases of recurrent, severe post-tonsillectomy bleeding. Materials and methods: Of the 120 patients treated at our tertiary centre between 2006 and 2010 due to post-tonsillectomy haemorrhage, 22 with recurrent, severe episodes of bleeding underwent further, advanced haemostasis investigation. Results: Underlying haemorrhagic disease was not diagnosed in any case. Isolated abnormal clotting factor levels were identified in two patients. Decreased fibrinogen concentration due to dilutional coagulopathy was found in nine cases (40.9 per cent). Conclusion: Recurrent, severe post-tonsillectomy haemorrhage is rarely related to undiagnosed haemostatic disorders. Thus, advanced haemostasis studies have little therapeutic relevance. However, repetitive post-tonsillectomy bleeding may be related to decreased fibrinogen levels due to dilutional coagulopathy. Therefore, fibrinogen concentration should be tested, and dilutional coagulopathy treated promptly.