Abstract:
Purpose: The purpose of our study was to review outcome of circumcision among children with bleeding disorders at our
institution and also to determine the impact of optimization leading to safe circumcision.
Methods: Data representing boys (age 0-16 years) who underwent routine circumcision at the Aga Khan University Hospital
(AKUH) between1988-2014 was retrospectively reviewed. Children with bleeding disorder were identified using
International Classification of Diseases (ICD) Code 64.0. Data was retrieved and confidentially was maintained. SPSS
version 19 was used for statistical analysis.
Results: During 26 years 13,200 circumcisions were performed at AKUH. Amongst these 8,463 (64.11%) were done by
using Plastibell, while 4,737 (35.88%) by open slit method. Only 23 (0.17%) children were identified with bleeding
disorder. Two groups were made, Group-A (n:15) children with known bleeding disorders having circumcision and Group-
B, (n:8) those in whom bleeding disorder was diagnosed after circumcision.
Median age of children in Group-A was 9 years. All children in Group-A underwent open circumcision. 10 patients had
Factor VIII deficiency, 2 had Glanzmann’s thrombasthenia, 1 had Factor IX deficiency, 1 had Quebec platelet disorder,
and 1 had Von Willebrand disorder.
Median age of children in Group-B was 3 months. 7 out of 8 underwent plastibell while one had circumcision by open
technique. 7 were diagnosed as Factor VIII deficiency and 1 diagnosed later to have Glanzmann's thrombasthenia. Statistical
analysis showed significant difference among these two groups’ p-value with respect to age (p-value 0.00) and family
history (p-value 0.04- Fisher’s exact test). Both groups had similar postoperative length of stay. Overall bleeding complication
rate after optimization was 13.33%.
Conclusion: With the help of hematologist and adequate Factor replacement, these children can be managed as daycare.
We suggest risks and benefit should be discussed with parents before procedure.
