Kanama bozukluğu olan çocuklarda sünnet deneyimi

Abstract

Tur kish Arc hi ves of Pe di at rics, pub lis hed by Ga le nos Pub lis hing Circumcision in children with bleeding diathesisAd dress for Cor res pon den ce: Tiraje Celkan MD, İstanbul University Cerrahpaşa Medical Faculty, Division of Pediatric Hematology-Oncology, İstanbul, Turkey E-mail: tirajecelkan@yahoo. Original Article Sum maryAim: Circumcision is one of the most commonly performed procedures in children, however there are few reports which describe circumcision in patients with bleeding disorders (BD). The aim of this study is to present our experience in circumcision of children with BD. Material and Method:We retrospectively searched the patient records of 18 children (3-14 years old) who were followed up at Cerrahpaşa Medical Faculty Pediatric Hematology Clinic for BD and who were circumcised at Cerrahpaşa Medical Faculty Pediatric Surgery Clinic between 2000 and 2010. Management strategies, complications and outcomes were reviewed. Results: Seven children had a BD related to the first phase of hemostasis; 3 children had Glanzman thrombasthenia, 2 had Bernard-Soulier syndrome and 2 had chronic immune thrombocytopenic purpura. Other 11 children were followed up for a BD related to the 2nd phase of hemostasis; 3 had von-Willebrand disease (vWD), 1 had factor V deficiency, 1 had haemophilia B and 6 children had haemophilia A. No patient with inherited platelet disorder and/or thrombocytopenia required platelet replacement. Circumcision was performed with fibrinolytics and fibrin glue in these patients and there was no bleeding. In children with haemophilia (without inhibitors) and vWD, 2-3 doses of factor replacement therapy (15-25/kg/d) which was started before surgery were given until after 24-48 hours of circumcision. Fibrinolytics and fibrin glue were also used in these patients and bleeding was not observed in any patient. In 2 hemophilia A patients with low responsing inhibitors, by-pass agents were used for 12 and 18 days respectively. Bleeding was controlled with sequential use of rFVIIa and aPCC. Conclusions: Children with a BD can be safely circumcised in a center with experience. In circumcision of children with BD, antifibrinolytics and local hemostatic agents are helpful in decreasing factor doses in haemophilics and offer the possibility to omit platelet transfusion in patients with platelet disorders. (Turk Arch Ped 2011; 46: 304-8)