Bleeding Following Circumcision in Patients with Platelet Delta Granule Storage Pool Deficiency

Background: Male circumcision is a common procedure, generally performed during the newborn period. Few reports have described circumcision in patients with bleeding disorders.

Objectives: To determine if male patients with a dense granule platelet function defect or storage pool deficiency (SPD) have an increased incidence of bleeding with newborn circumcision.

Methods: This is a retrospective analysis. The population analyzed is followed at the Northwest Ohio Hemophilia Center. The ATHEN data set and medical records were used to look at the incidence of significant bleeding with circumcision from 2000-2020. These subjects were diagnosed with SPD later in life. Intraoperative/postoperative bleeding and bleeding severity were the main outcomes evaluated.

Results: Of 262 male subjects identified, 153 subjects were circumcised. Circumcision was performed at a median age of 2 days (range, 1 day-4 months). The main indication for circumcision was parental request. Device technique was the procedure of choice. All subjects were not known to have any bleeding disorder at circumcision, and were diagnosed later in life as having SPD. Family history of bleeding disorders was positive in 70 subjects (SPD in 68 subjects and Von Willebrand’s disease (vWD) in 2 subjects). Median severity of granule deficiency was 2.76 dense granules/platelet (range, 1.12-3.82 DG/Plt). None of the subjects had intraoperative bleeding. Three subjects (2%) had postoperative bleeding and only one (0.65%) required ER intervention to stop bleeding.

Conclusion: The overall incidence of bleeding in our subjects with SPD who were undiagnosed and untreated at circumcision, is comparable to that reported for patients without a bleeding disorder (0.1–24%).