Citation
J Haem Pract 2017; 4(1). doi: 10.17225/jhp00092

Authors: Assaf Arie Barg, Sarina Levy Mendelovich, Shadan Lalezari, Shirley Azar Avivi, Dalia Bashari, Gili Kenet

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

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

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

Dalia Bashari
The Israeli National Hemophilia Center and Thrombosis Unit, Sheba Medical Center, Tel Hashomer, Israel.

Gili Kenet
Sackler School of Medicine, Tel Aviv University, Israel, and The Israeli National Hemophilia Center and Thrombosis Unit, Sheba Medical Center, Tel Hashomer 52621, Israel.. Email: gili.kenet@sheba.health.gov.il

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 post-circumcision 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.

Acknowledgements

The authors have advised no interests that might be perceived as posing a conflict or bias.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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. doi: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.

The Journal of Haemophilia Practice is published by Haemnet.

Haemnet is a registered charity that brings together and gives a voice to haemophilia nurses, physiotherapists and allied health care professionals, providing forums for collaborative research, educational activities and support.