Surgery in patients with haemophilia and high responding inhibitors: Izmir experience

Balkan, Can; Karapınar, Deniz Yılmaz; Aydoğdu, Semih; Özcan, Coşkun; Ay, Yılmaz; Akın, Mehmet; Kavaklı, Kaan

doi:10.1111/j.1365-2516.2010.02329.x

Cited by 31 publications

(45 citation statements)

References 37 publications

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“…With the introduction of by ‐ passing agents, surgical interventions can be performed safely in haemophilia patients with inhibitors [18,19]. Any severe bleeding was not seen in our haemophilia patients with inhibitors.…”

Section: Discussionmentioning

confidence: 99%

Circumcision and complications in patients with haemophilia in southern part of Turkey: Çukurova experience

Şaşmaz¹,

Antmen²,

Leblebisatan³

et al. 2011

Haemophilia

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Circumcision is the oldest and most frequent surgical procedure in the world and especially in Turkey as is seen in the other Islamic countries because of religious and traditional pressures. In this study, we aim to report the experience of circumcision at Çukurova University in a total of 76 patients with haemophilia between 1990 and 2011. We retrospectively reviewed medical records of 69 haemophilia patients without inhibitors and seven haemophilia patients with inhibitors who had been circumcised. Before the year 2000, factor concentrates were given before and after circumcision for 6-7 days. After 2000, we used fibrin glue together with factor concentrates for only 3 days. By-passing agents were used for circumcision in haemophilia patients with inhibitors. Twelve of 69 patients without inhibitors were referred to our centre with bleeding after the circumcision before diagnosis of haemophilia. Nine of these twelve patients had severe life threatening bleeding and three of them had moderate bleeding. Sixty-four patients with haemophilia were circumcised in our centre under general anaesthesia except for three patients who were given local anaesthesia. Thirteen of 57 haemophilia patients (22.8%) without inhibitors had seven mild and six moderate bleeding complications. A few patients had significant bleeding, despite adequate factor replacement. Five of seven haemophilia patients with inhibitors had two moderate and three mild bleeding complications. Our experience showed that circumcision for patients with haemophilia should be carefully performed by surgeons together with paediatric haematologist, under appropriate conditions in haemophilia centres which has comprehensive coagulation lab.

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Section: Discussionmentioning

confidence: 99%

Circumcision and complications in patients with haemophilia in southern part of Turkey: Çukurova experience

Şaşmaz¹,

Antmen²,

Leblebisatan³

et al. 2011

Haemophilia

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“…Hemophiliacs with inhibitors had more bleeding complications and a longer period to healing [33, 34]. …”

Section: Discussionmentioning

confidence: 99%

Circumcision in hemophilia using low quantity of factor concentrates: experience from Dakar, Senegal

et al. 2017

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BackgroundCircumcision in hemophiliacs is a delicate surgery because of bleeding risks that could be avoided by adequate substitution of coagulation factor. This practice is very challenging in countries where anti hemophilic treatment is inaccessible. The study aimed to evaluate a circumcision protocol in hemophilia A using low quantities of factor concentrates.MethodsThis prospective study included 26 hemophiliacs A who underwent circumcision in 2014. Medical treatment protocol using low quantity of factor concentrates was drafted by physicians of the Hemophilia Treatment Center and the surgical protocol by experienced surgeons. Assessment criteria were: number of hospitalization days, number of exposure days to factor concentrates, delay to healing and occurrence of bleeding events.ResultsMean age was 9.6 years (1–30). Hemophiliacs patients were classified as severe (n = 8), moderate (n = 9) and mild form (n = 9). Mean number of exposure days to factor VIII concentrates was 6.9 days (5–12) in children and 10.75 days (7–16) in adults (p = 0.0049); mean number of hospitalization days was 3.68 days (2–10) in children and 13.5 days (13–15) in adults (p = 0.0000); delay to healing was 26.47 days (20–35) in children and 25.25 days (22–30) in adults (p = 0.697); five haemophiliacs (19.2%) presented bleeding events after the circumcision. The mean amount of FIII concentrates used per patient was 1743 IU (810–2340).ConclusionThe study shows treatment protocol using low quantity of factor concentrates is efficient in hemophilia patients who underwent circumcision.

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“…The bleeding in this patients could only be controlled on the 15th day after using intensive by-pass agent and 2 units of erythrocyte suspension had to be transfused because of bleeding. Ankaferd (blood stopper) was used in one patient (20)(21)(22)(23)(24). In a study by Zülfikar et al (25) where the authors shared their 11-year experience of hemophilic patients with inhibitor, bleeding could be controlled with difficulty in two patients who were circumcised.…”

Section: Discussionmentioning

confidence: 99%

“…There are few studies about circumcision experience in hemophilia patients with inhibitor. In the surgical experience of Balkan et al (20) in hemophilic patients with inhibitor, circumcision was reported in one patient. The bleeding in this patients could only be controlled on the 15th day after using intensive by-pass agent and 2 units of erythrocyte suspension had to be transfused because of bleeding.…”

Section: Discussionmentioning

confidence: 99%

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Kanama bozukluğu olan çocuklarda sünnet deneyimi

Özdemir¹,

Çelik²,

Bulut³

et al. 2011

tpa

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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)

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Surgery in patients with haemophilia and high responding inhibitors: Izmir experience

Cited by 31 publications

References 37 publications

Circumcision and complications in patients with haemophilia in southern part of Turkey: Çukurova experience

Circumcision and complications in patients with haemophilia in southern part of Turkey: Çukurova experience

Circumcision in hemophilia using low quantity of factor concentrates: experience from Dakar, Senegal

Kanama bozukluğu olan çocuklarda sünnet deneyimi

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