Galukande Moses, Kahendehe Carol, Buuza Eria, Sekavuga Denis Bbaale
Surgery Department, Mulago Hospital, Mulago Hill, P. O. Box 7072, Kampala, Uganda ; International Hospital Kampala, Plot 4686 St. Barnabas road, Kisugu, P.O. Box 8177 Kampala, Uganda.
International Hospital Kampala, Plot 4686 St. Barnabas road, Kisugu, P.O. Box 8177 Kampala, Uganda.
Int J Emerg Med. 2015 Apr 10;8:8. doi: 10.1186/s12245-015-0056-5. eCollection 2015.
The majority of bleeding disorders worldwide are undiagnosed. Their moderate or severe forms are associated with considerable morbidity and mortality. In the advent of mass male circumcision for the partial prevention of HIV, undiagnosed and diagnosed cases of bleeding disorders are likely to be increasingly encountered. The ability to screen, diagnose, and manage these cases appropriately will mitigate associated adverse events. We describe three cases of prolonged bleeding after adult voluntary medical male circumcision (VMMC) and propose program measures.
A descriptive case series at tertiary urban hospital serving a VMMC program. The cases were recruited consecutively over a 3-year period. Standard laboratory tests were used to confirm diagnosis. Written informed consent was obtained from each subject.
Three cases were described of previously undiagnosed hemophilia A males circumcised during routine VMMC service delivery. They had presented with complaints of prolonged (non-stop or recurring) bleeding. They were aged 16, 22, and 24 years, of low socioeconomic background, with limited formal education. Whereas two of the three were aware of a tendency to prolonged bleeding from minor cuts, they did not volunteer these histories. The patients were referred to a hospital with the resources to test and administer recombinant factor VIII in Kampala (the capital city) 3, 9, and 16 days after circumcision. Two had received whole blood transfusions enroute to this hospital. All three were diagnosed with mild or moderate hemophilia A. Factor IX levels were all within normal range. In all three cases, the bleeding stopped within hours of the initial factor VIII infusion, and two to three maintenance doses were given over the subsequent 2 to 3 days for each patient.
Sensitization of health workers in safe male circumcision (SMC) programs for pre-operative diagnosis and appropriate referral is highly recommended.
全球大多数出血性疾病未得到诊断。其中度或重度形式与相当高的发病率和死亡率相关。在大规模男性包皮环切术用于部分预防艾滋病病毒的情况下，未诊断和已诊断的出血性疾病病例可能会越来越多地出现。对这些病例进行适当筛查、诊断和管理的能力将减少相关不良事件。我们描述了三例成人自愿医学男性包皮环切术（VMMC）后出血时间延长的病例，并提出了项目措施。
在一家为VMMC项目服务的城市三级医院进行描述性病例系列研究。这些病例在3年期间连续招募。使用标准实验室检测来确诊。从每个受试者处获得书面知情同意。
描述了三例在常规VMMC服务过程中接受包皮环切术的先前未诊断出的甲型血友病男性病例。他们均出现了出血时间延长（不停或反复出血）的症状。他们的年龄分别为16岁、22岁和24岁，社会经济背景较低，正规教育有限。虽然三人中有两人意识到轻微割伤后有出血时间延长的倾向，但他们并未主动提及这些病史。这些患者在包皮环切术后3天、9天和16天被转诊至坎帕拉（首都）一家有资源检测和使用重组凝血因子VIII的医院。其中两人在前往这家医院的途中接受了全血输血。所有三人均被诊断为轻度或中度甲型血友病。凝血因子IX水平均在正常范围内。在所有三例病例中，首次输注凝血因子VIII后数小时内出血停止，随后2至3天内为每位患者给予了两至三次维持剂量。
强烈建议在安全男性包皮环切术（SMC）项目中提高卫生工作者对术前诊断和适当转诊的认识。
