To circumcise or not to circumcise? Circumcision in patients with bleeding disorders

Abstract

Circumcision is one of the most common procedures performed in male neonates, but few published reports have described circumcision in patients with bleeding disorders. The aim of this study was to analyse outcomes of circumcision among children evaluated at our institution to determine the extent of complications and to provide guidelines for circumcision management. We searched our patient database for records of children who were followed up at the Mayo Clinic Comprehensive Hemophilia Center from 2000 through 2007 and who had been circumcised. We retrospectively reviewed the medical records to document complications and determine management strategies in this patient population. Of 55 children and young adults identified (median [range] age, 15 years [11 months to 21 years]), 48 patients were circumcised. Indications for circumcision were parental request (n = 45) and medical recommendation (n = 3). Twelve of 21 patients with a known bleeding disorder at the time of circumcision received factor replacement before the procedure. Three of these 21 patients had bleeding complications. Of the other 27 patients, who were diagnosed later in life as having a bleeding disorder, 8 had bleeding complications. The overall incidence of bleeding after circumcision was 23% (11/48). The 23% overall incidence of bleeding complications in our patients with bleeding disorders is comparable to that reported for patients without a bleeding disorder (0.1-35%). Some of our patients had significant bleeding despite adequate factor replacement before and after the procedure. Parents and patients must be aware that bleeding risk is a possibility despite adequate factor replacement for hemostasis.

Design of the INHIBIT trial: preventing inhibitors by avoiding ‘danger’, prolonging half-life and promoting tolerance

“…While the method of infusion is a risk factor, for example, via central line placement , especially in those who bleed with the procedure [26,29], by contrast, the type of product, recombinant versus plasma derived, full length versus B-domain deleted or von Willebrand factor content does not appear to be a risk [28]. Neither is circumcision , a procedure associated with bleeding in as many as 35% of children with hemophilia, associated with inhibitor risk [36,37]. In Israel, where nearly all male infants undergo the procedure, the inhibitor rate is 30% [KENET G, PERS.…”

Outcome of harmonic scalpel circumcision in children with hemophilia

“…3 Few publications are available in the literature about circumcision in patient with hemophilia. 3,9,11,12,19,20 The are several techniques described to induce hemostasis during circumcision in a patient with hemophilia such as fibrin glue and fibrin glue combined with the infusion of the deficient factor. 11,21 Up to our knowledge, no study described the use of the harmonic scalpel in circumcision and this will be the first report.…”

CUA guideline on the care of the normal foreskin and neonatal circumcision in Canadian infants

“…However, this requires an ability to recognize the severity of the anomaly and therefore as a general rule, all boys with hypospadias should ideally not have a circumcision, prior to a consultation by a pediatric urologist. Children with blood dyscrasias can undergo circumcision, under appropriate treatment and care [178][179].…”