A neonate with von Willebrand disease (vWD) may bleed following circumcision. Fried et al described steps that can be used to avoid excessive bleeding. The authors are from Southern California Permanente Medical Group and Children's Hospital in Los Angeles.
Patient selection: neonate with von Willebrand disease
Steps used:
(1) Avoid excessive crushing of the foreskin.
(2) Ligate any small blood vessels.
(3) Apply topical thrombin along the resection margin.
(4) Apply a dressing of Surgicel with collagen (Avitene).
The patient described had a von Willebrand factor antigen of 44 percent and a aPTT of 38 seconds. The protocol appears reasonable for mild vWD but additional precautions would be needed if severe vWD is present.
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