Neonatal circumcision in patients with haemophilia is safe – a single centre experience

Assaf Arie Barg; Sarina Levy Mendelovich; Shadan Lalezari; Shirley Azar Aviv; Dalia Bashari; Gili Kenet

doi:10.17225/jhp00092

Abstract

Abstract

Consensus evidence-based guidelines regarding prophylactic treatment for circumcision in patients with haemophilia are lacking. In this study, we retrospectively examined the results of circumcision of 40 consecutive neonates with haemophilia, diagnosed after delivery. Our protocol included application of a single dose of factor replacement prior to the procedure and 3 days’ oral treatment with tranexamic acid. Only 3/40 neonates with haemophilia experienced mild postcircumcision bleeding. No major or any life-threatening bleeds were encountered. As the therapy administered was minimal and the procedure simple and feasible, we concluded that circumcision in neonates with haemophilia should be performed according to family’s and physician’s discretion. Avoidance of circumcising male babies with haemophilia due to fear of bleeding complications is not supported by the results shown within our patient cohort.

Article

View Full Article

References

1. Weiss HA, Larke N, Halperin D, Schenker I. Complications of circumcision in male neonates, infants and children: a systematic review. BMC Urology 2010: 10:2. https://doi.org/10.1186/1471-2490-10-2.
2. Niku SD, Stock JA, Kaplan GW. Neonatal circumcision. Urol Clin N Am 1995; 22: 57 65.
3. Kearney S, Sharathkumar A, Rodriguez V, et al. Neonatal circumcision in severe haemophilia: a survey of paediatric haematologists at United States Hemophilia Treatment Centers. Haemophilia 2015; 21: 52–7.
4. Gouw SC, van der Bom JG, van den Berg HM. Treatment-related risk factors of inhibitor development in previously untreated patients with hemophilia A: the CANAL cohort study. Blood 2007; 109: 4648-54.
5. Gouw SC, van den Berg HM, Fischer K, et al. Intensity of factor VIII treatment and inhibitor development in children with severe hemophilia A: the RODIN study. Blood 2013; 121(20): 4046–55.
6. Kavalki K, Aledort LM. Circumcision and haemophilia: a perspective. Haemophilia 1998; 4: 1–3.
7. YIilmaz D, Akin M, Ay Y, et al. A single centre experience in circumcision of haemophilia patients: Izmir protocol. Haemophilia 2010; 16: 888–91.
8. Makris M. Is VIII worse than IX? Blood 2009; 114(4): 750-1.
9. Melchiorre D, Linari S, Manetti M, et al. Clinical, instrumental, serological and histological findings suggest that hemophilia B may be less severe than hemophilia A. Haematologica 2016; 101(2): 219-25.
10. Eckhardt CL, van Velzen AS, Peters M, et al. Factor VIII gene (F8) mutation and risk of inhibitor development in non-severe hemophilia A. Blood 2013; 122(11): 1954-62.
11. Andrew M. Developmental hemostasis: relevance to hemostatic problems during childhood. Semin Thromb Hemost 1995; 21: 341–56.

PDF Download

Download PDF

Open in full-page viewer

Authors

Assaf Arie Barg

The Israeli National Hemophilia Center and Thrombosis Unit, Sheba Medical Center, Tel Hashomer, and Sackler School of Medicine, Tel Aviv University, Tel Aviv Israel
Sarina Levy Mendelovich

The Israeli National Hemophilia Center and Thrombosis Unit, Sheba Medical Center, Tel Hashomer, and Sackler School of Medicine, Tel Aviv University, Tel Aviv Israel
Shadan Lalezari

The Israeli National Hemophilia Center and Thrombosis Unit, Sheba Medical Center, Tel Hashomer, and Sackler School of Medicine, Tel Aviv University, Tel Aviv Israel
Shirley Azar Aviv

The Israeli National Hemophilia Center and Thrombosis Unit, Sheba Medical Center, Tel Hashomer, and Sackler School of Medicine, Tel Aviv University, Tel Aviv Israel
Dalia Bashari

The Israeli National Hemophilia Center and Thrombosis Unit, Sheba Medical Center, Tel Hashomer, Israel
Gili Kenet

gili.kenet@sheba.health.gov.il

Sackler School of Medicine, Tel Aviv University, Israel, and The Israeli National Hemophilia Center and Thrombosis Unit, Sheba Medical Center, Tel Hashomer 52621, Israel