Abstract:

Post operative haemorrhage is the most common and frightening complication after tonsillectomy. Primary haemorrhage seen in the first 24 hours is more common and generally related with inadequate hemostasis. Secondary haemorrhage is rare, but more frightening. Post operative haemorrhage is less common in pediatric population than in adult population. Complete blood count, hemostatic parameters, bleeding and coagulation time should be examined before surgery. An eleven-year old male patient was admitted to the hospital with abundant haemorrhage who had undergone adenotonsillectomy operation 19 days before admission.His hematological values were normal preoperatively Active bleeding in the right tonsil bed and conglomerated clot in the oral cavity were seen in the physical examination. The patient was taken to sugery in general anesthesia and local Ankaferd blood stopper dressing, electrocauterization and plica suturation were performed and eventually bleeding was stopped. Tranexamic acid and vitamin K were administered also. 1 unit of erythrocyte suspension and fresh frozen plasma were also transfused. After achievement of clinical stability, coagulation factor levels were examined by the Pediatric Hematology department and Factor7 and Factor 13 levels were found lower than normal. Although minor coaagulation factor deficiencies do not effect the hematological tests performed before surgery, it can cause late post-tonsillectomy haemorrhage. Therefore, this case with secondary haemorrhage after tonsillectomy was presented focusing the initiation time of bleeding, hematological parameters and clinical management with the ligth of recent literature.

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