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Vitamin K deficiency bleeding and early infant male circumcision in Africa

Rebeca M Plank1, Tara Steinmetz, David C Sokal

  • 1Division of Infectious Disease, Brigham and Women's Hospital, Boston, Massachusetts; Botswana-Harvard Partnership for HIV Research and Education, Gaborone, Botswana; the Department of Public Policy, Duke University, Durham, North Carolina; the Clinical Sciences Department, FHI 360, Durham, North Carolina; the Haemostasis Research Unit, Centre for Haemostasis & Thrombosis, St. Thomas' Hospital, London, United Kingdom; and the Department of Pediatrics and Child Health, Mbarara University of Science and Technology, Mbarara, Uganda.

Obstetrics and Gynecology
|July 26, 2013
PubMed

Insights

Infants undergoing circumcision in Africa may face bleeding risks due to vitamin K deficiency. Prompt administration of vitamin K (phytomenadione) effectively stopped prolonged post-procedure bleeding in a neonate.

Area of Science:

  • Neonatal care
  • Pediatric surgery
  • Infectious disease prevention

Background:

  • Male circumcision is being trialed in Africa as an HIV prevention strategy.
  • Infants aged 1-60 days are at risk of vitamin K deficiency bleeding, especially when breastfed.
  • Postcircumcision bleeding is a significant concern in this population.

Observation:

  • A neonate in a circumcision trial experienced prolonged bleeding (90 minutes) post-procedure.
  • The infant had not received standard prophylactic vitamin K.
  • 2 mg of phytomenadione (vitamin K1) was administered intramuscularly.

Findings:

  • Intramuscular vitamin K1 rapidly resolved the infant's bleeding within 30 minutes.
  • This highlights the extremely rapid action of vitamin K, which is often underestimated.
  • Vitamin K prophylaxis is a cost-effective intervention for neonates.

Implications:

  • Vitamin K should be readily available, particularly in low-resource settings with limited blood products.
  • Increased awareness and availability of neonatal vitamin K are crucial.
  • Including vitamin K in the World Health Organization's Model List of Essential Medicines for Children is recommended.
Abstract

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