Occult Hematological Disorders Unmasked by ENT Surgery: Case Series Finds

The case series findings were published in September 2026 in the Indian Journal of Otolaryngology and Head & Neck Surgery by S. M. Venkateswarlu and M. Neelima.

The report details two male patients presenting with recurrent epistaxis who underwent routine otolaryngologic surgical procedures following unremarkable standard preoperative investigations. In both instances, surgical intervention served as a provocative diagnostic stressor, revealing severe underlying blood disorders upon the development of persistent postoperative hemorrhage.

Case 1: 33-Year-Old Male

A 33-year-old man presented with a history of recurrent epistaxis and previous blood transfusions. Following initial preoperative laboratory testing that yielded apparently acceptable results, he underwent septoplasty combined with inferior turbinectomy. Postoperatively, the patient experienced recurrent, unexpected surgical bleeding characterized by fluctuating hemoglobin levels and unstable platelet counts. Prompt hematological re-evaluation was initiated to determine the cause. Bone marrow evaluation revealed a hypercellular reactive marrow exhibiting prominent erythroid hyperplasia alongside marked megakaryopoiesis. These pathological features supported active peripheral platelet destruction rather than a primary bone marrow failure state.

Case 2: 18-Year-Old Male

An 18-year-old man with a lifelong history of intermittent epistaxis underwent adenoidectomy followed subsequently by functional endoscopic sinus surgery. Despite repeatedly normal routine coagulation profiles, he developed persistent postoperative epistaxis. Advanced laboratory investigation was subsequently undertaken. Platelet aggregometry demonstrated severely reduced aggregation responses to adenosine diphosphate, collagen, and arachidonic acid, while the response to ristocetin remained entirely preserved. Subsequent flow cytometry showed preserved expression of glycoprotein IIb/IIIa and GP Ib/IX cell surface receptors, ruling out Glanzmann thrombasthenia and Bernard–Soulier syndrome. These diagnostic findings confirmed an inherited non-receptor qualitative platelet function disorder.

Routine preoperative coagulation screens focus on standard secondary hemostasis but fail to identify qualitative platelet defects or dynamic peripheral consumption patterns. Surgical procedures act as diagnostic stressors that expose these underlying subclinical conditions. Advanced diagnostic testing—such as serial complete blood counts, bone marrow aspirates, platelet aggregometry, and surface receptor flow cytometry—is crucial for identifying specific hematological etiologies when initial laboratory parameters appear entirely normal.

Implications for Clinicians

Clinicians must maintain high vigilance when encountering disproportionate or recurrent postoperative hemorrhage following ear, nose, and throat procedures. When standard screening tests are unremarkable, providers should evaluate prior transfusion history, track serial blood counts, and initiate early hematology consultation. Recognizing these subtle bleeding diatheses ensures prompt multidisciplinary care, prevents inappropriate surgical re-exploration, and directs tailored patient management.

Reference

Venkateswarlu, S. M., & Neelima, M. (2026). Unmasking Occult Hematological Disorders After ENT Surgery: A Multidisciplinary Clinical Experience from Two Cases of Recurrent Epistaxis. Indian Journal of Otolaryngology and Head & Neck Surgery, 2026.