2022 Volume 82 Issue 5 Pages 395-398
Hemophilia A is an X-chromosome-linked recessive inherited congenital bleeding disorder that is caused by coagulation protein factor Ⅷ deficiency or dysfunction. Herein, we report a case of mild hemophilia A diagnosed after a postoperative bleeding event following palatine tonsillectomy, indicating the importance of the patient’s bleeding history than the laboratory test results in predicting postoperative bleeding. A 3-year-old boy underwent bilateral palatine tonsillectomy and adenoidectomy for snoring and apnea. The activated partial thrombin time （APTT） measurements in two preoperative coagulation screening tests were 34.9 s and 45.6 s, suggesting no necessary specific interventions. The surgery was performed without complications, but bleeding occurred on the third postoperative day, requiring emergent hemostasis. On postoperative day 6, he required transfusion and mechanical ventilation under general anesthesia because of a rebleeding event that was difficult to control even with emergent hemostasis. His APTT did not increase in the subsequent examination. However, his factor Ⅷ level decreased to 26.3％, leading to a hemophilia A diagnosis. A detailed interview after the postoperative bleeding revealed a hematoma due to an upper lip strip suturing injury at 9 months of age. Here, a mildly prolonged APTT of 45.6 s was detected in only one of the three coagulation screenings. Postoperative hemorrhage could have been prevented by considering hemophilia if the patient’s hemostatic disorder history had been preoperatively analyzed in detail. In conclusion, boys with a history suggestive of hemostatic disorder should be considered to have mild hemophilia even if APTT is not prolonged.
