Analysis was carried out on 368 children set for tonsillectomy and/or adenoidectomy at the Department of Otorhinolaryngology, Head, and Neck Surgery, Affiliated Children’s Hospital of Capital Institute of Pediatrics from October 2019 to January 2020. Five children had prolonged activated partial thromboplastin time (APTT) and coagulation factor abnormalities pre-surgery. A control group of 10 children matched in gender and age underwent the same procedures during the same period by the same surgeon for comparison. The study monitored various factors such as surgery duration, bleeding during and after surgery, and recovery time.
Participants and Methods
General Information
An evaluation took place between October 2019 and January 2020, involving 368 children prepared for tonsillectomy and/or adenoidectomy at the Department of Otolaryngology, Head, and Neck Surgery in the Children’s Hospital affiliated with the Capital Institute of Pediatrics. Five of these children displayed prolonged APTT and coagulation factor abnormalities pre-surgery. To compare, 10 control children with similar demographics underwent the same procedures during the same period by the same surgeon. Tracking encompassed surgical timing, bleeding volumes intraoperatively and postoperatively, and recovery duration.
Detection Equipment and Reference Range
Utilizing the ACL TOP system, the study conducted coagulation function and factor assays. Reference ranges for normal coagulation function and factors are detailed in Tables 1 and 2.
Detection Indicators and Criteria
Activated Partial Thromboplastin Time (APTT)
Within this research, APTT measurements exceeding normal values by more than three seconds were deemed significant. Coagulation factor assessment included Factors II, V, VIII, IX, X, and XII. Inclusion criteria for the experimental group involved extended APTT and reduced factor levels, indicating mild coagulation abnormalities, excluding hemophilia A cases. Surgical timing was measured from the beginning of the procedure until complete hemostasis was achieved, utilizing a 70° endoscope system and low-temperature plasma radiofrequency system for tissue removal.
Intraoperative Blood Loss Assessment
Blood loss estimation during surgery was determined by subtracting the volume of sodium chloride solution from the total bodily fluid amount.
Postoperative Observation
Post-surgery, both groups received antibiotics for infection prevention. Various symptoms and recovery were noted, alongside monitoring for bleeding within 24 hours and after 24 hours.
Statistical Analysis
Statistical analysis was conducted using SPSS 24.0 software, employing descriptive statistics for data evaluation. Normal distribution numerical data was expressed as mean ± standard deviation. Surgical timing, bleeding volume, and hospital stay length were analyzed using paired sample t-tests, with significance at P < 0.01.
Results
The research group consisted of 5 male children aged 3 to 6 years, with a mean age of 4.6 ± 1.1 years. All children displayed prolonged APTT in both assessments. Specifically, 2 patients had deficiencies in Factors IX and XII, 1 in Factors X and XII, 1 solely in Factor XII, and 1 had multiple deficiencies. Notably, all children had Factor XII deficiency. Surgical duration and bleeding volumes did not significantly differ between the experimental and control groups. No active bleeding was observed post-surgery in any of the children. Follow-up showed no active bleeding episodes and normal coagulation function at 6 months.
Recent studies have shown a link between APTT and Factor XII activity, especially in children with recurrent infections. It was discovered that recurrent infections can increase antiphospholipid antibody (APL) levels, leading to a slight rise in APTT. Another study revealed that various factors, such as infection, immunity, and ethnicity, can affect coagulation function and Factor XII levels in children. Interestingly, the group with immune disorders had significantly higher APTT and lower Factor XII activity compared to the control group. Microcirculatory and coagulation issues related to thrombosis are common during systemic viral infections like COVID-19.
Our research included a postoperative evaluation of children, showing a normalization in their coagulation function and Factor XII levels. Significant differences were observed in APTT and Factor XII levels before and after surgery, in line with previous findings. This suggests that mild coagulation abnormalities in children often coincide with recurrent infections. Following T&A procedures to remove the infection source and decrease respiratory infections, both coagulation function and Factor XII activity can return to normal levels.
Irregularities in coagulation factors are not rare in children, highlighting the need to screen at-risk children before surgery to determine their coagulation factors. In our study, children with high APTT and Factor XII deficiency did not show a notable bleeding tendency, and the lack of Factor XII is not a reason to avoid surgery. A follow-up examination six months post-surgery displayed significant improvement, indicating a potential link to chronic inflammation. The research followed Helsinki Declaration guidelines and received ethical approval. Funding was provided by various programs, and the authors disclose no conflicts of interest in this study.
References:
- Apostel H L, De Bie B, Kats S, et al. Prolonged baseline ACT during cardiac surgery due to factor XII deficiency. Ann Card Anaesth. 2022;25(2):229–232. doi:10.4103/aca.aca_255_20
- Wang KL, Huang XL, Qian SX. Rare coagulation factor deficiency in 3 cases. Zheji Med Sci. 2021;43(4):430–432.
- Coelho S, Augusto FM, Arruda LB. Pathways and implications of viral infection-driven activation of kallikrein-kinin system (KKS). Viruses. 2024;16(2):245. doi:10.3390/v16020245
- Frauenknecht K, Lackner K, von Landenberg P. Antiphospholipid antibodies in pediatric patients with prolonged activated partial thromboplastin time during infection. Immunobiology. 2005;210(10):799–805. doi:10.1016/j.imbio.2005.10.012
- Malbora B, Bilaloglu E. Lupus anticoagulant positivity in pediatric patients with prolonged activated partial thromboplastin time: a single-center experience and review of literature. Pediatr Hematol Oncol. 2015;32(7):495–504. doi:10.3109/08880018.2015.1065302