A Case Report of Congenital Afibrinogenemia and Literature Review of Management of Post-circumcision Bleeding

Abstract

We present a case of bleeding from circumcision in a full-term newborn male resulting from a rare coagulopathy, congenital afibrinogenemia, and a review of the literature regarding the management of bleeding after circumcision. Bleeding was managed with silver nitrate, suturing, thrombin powder, Arista TM AH (absorbable hemostatic particles; Becton, Dickinson and Company, Franklin Lakes, USA), FFP (fresh frozen plasma), and cryoprecipitate. The Fibrinogen level was less than 30 mg/dl (ref 150-430 mg/dl). The diagnosis of congenital afibrinogenemia was confirmed by a gene test. The baby was found to have a heterozygous pathogenic variant (c.510+1G>T) and a heterozygous likely pathogenic variant (c.1037del) in the FGA gene.

Early Diagnosis and Management of Congenital Afibrinogenemia: A Case Report of Umbilical Stump Bleeding

“…In neonates, afibrinogenemia is particularly concerning as it poses serious challenges due to its early onset and the potential for severe bleeding episodes. Bleeding due to fibrinogen disorders in the neonatal period may present at different sites, including mucous membranes, umbilical stumps, and bleeding following circumcision in male infants [ 3 , 4 ]. Therefore, it is crucial for healthcare professionals to recognize the signs and symptoms of afibrinogenemia in the neonatal period to initiate care and management rapidly.…”