Mayo Clinic Examines Circumcision-Induced Bleeding
Horizons in Hemophilia, August 2010
In March, researchers at the Mayo Clinic (MC) in Rochester, MN, published a retrospective study of circumcision in patients with bleeding disorders. The purpose of the study was to examine the outcomes of circumcisions performed on patients who were evaluated at MC to determine the extent of related complications and develop guidelines for clinical management. The lead author of the study was Vilmarie Rodriguez, MD, Division of Pediatric Hematology and Oncology at MC.
Investigators looked at the records of 48 children and young adults who had been circumcised from 2000 -2007. They ranged from 11 months to 21 years old, with an average age of 15. Of these, 21 had a known bleeding disorder at the time of circumcision: 15 had hemophilia A, 2 had hemophilia B and 4 had von Willebrand Disease. Twelve of the 21 patients were treated with factor products prior to the procedure; three experienced bleeding complications.
The remaining 27 patients were diagnosed with bleeding disorders later in life. Among them, eight experienced bleeding complications. The overall incidence of bleeding post-circumcision was 11/48 patients, or 23%. The results led investigators to report that this incidence rate in bleeding disorder patients is “comparable” to that reported for unaffected children. They also reported that some patients still experienced significant bleeding despite what was considered adequate factor therapy given before and after circumcision.
“Risks and benefits should be discussed with parents before the procedure, and it should be stressed that bleeding can still occur despite adequate factor replacement. The patient should be observed in the hospital during and after the circumcision procedure to allow prompt intervention if bleeding occurs,” concluded the authors.
The study, “To Circumcise or Not to Circumcise? Circumcision in Patients with Bleeding Disorders,” was published in the March 2010 issue of Haemophilia.