ENT surgery in a patient who bruises easily

Should we be concerned when qualifying a patient who bruises easily despite normal coagulation test results for ear, nose, and throat (ENT) surgery?

Alfonso Iorio, MD, PhD: Not usually. ENT surgery does not carry a high risk of complicated bleeding. There might be local bleeding but it is usually not complex to treat, and the diagnostic yield of the test is not sufficient to perform a specialized test.

Unless there is familiality for bleeding, just bruising or ecchymosis in kids, particularly if confined to the lower part of the body, can be considered idiopathic. Normality of test results excludes the most severe diseases. You can still have factor XIII deficiency but it is [a risk of] one in a million, so it is not worth testing everyone. Outside familiality, normal screening tests are enough to consider ENT surgery safe.