2024-04-01 10:55:13
– First of all, what is hemophilia?
Hemophilia is a genetic disease which results in a bleeding disorder and which mainly affects boys. One in 5,000 boys born may have hemophilia.
In other words, when bleeding begins in a child with hemophilia, especially if he is young, he will bleed for a long time and could even lead to death if he does not take adequate treatment.
As he grows up, new symptoms appear in this little boy with hemophilia. In fact, you can find bruises on your body, bruises or even hematomas. Later, we can have hemarthroses.
- Can a person have hemophilia without a family history? What are the risks associated with circumcision?
According to studies carried out by the World Federation of Hemophilia, 30% of cases of hemophilia are sporadic cases. We can even say that now the figure has increased, reaching 50%.
In other words, the disease can occur without any family history. Many families have their child circumcised on the 27th day of the holy month without medical tests. And unfortunately, we have unpleasant surprises every year. The reason: the parents have no history of hemophilia in their family and do not even know what it is exactly.
It is true that hemophilia is a hereditary disease, but more than 30% of cases are sporadic. And without medical tests, we can’t know that. Before, Algerian families had their children circumcised before the start of the school year, which gave us time to screen. Today we are facing a new phenomenon.
The majority of families perform circumcision, either during the 27th day of the holy month or 7 days after the birth of the child, without medical tests. Which leads to unpleasant surprises.
In fact, either the parents take the child directly to the hospital and ask the surgeon to operate without preoperative assessment or some families even bring a doctor, or even a nurse, to the house to perform the surgical procedure without think about doing the analyses.
And unfortunately, there are often deaths. Moreover, we often receive emergency calls, generally at night, from parents whose child has been circumcised but does not stop bleeding. We then refer them to the pediatric services we know or the hemophilia centers so that the child can be taken care of and of course, we start by doing an assessment.
- What tests should be included in the assessment before circumcision?
We first analyze the TP, the TCK. Normally, the hemostasis assessment requested should be a standard for each child. You should know that in the case of families who have a history of hemophilia (a brother or uncle with hemophilia), it is essential to prepare all the girls in the family for the fact that they can have children with hemophilia.
And they must themselves inform the gynecologist about this history. But the danger arises in families who have never heard of hemophilia. Here, one must consider circumcision as a blessing.
And for good reason: if we were to standardize the complete hemostasis assessment for all children as has been indicated and guided by the Ministry of Health for several years now, we can detect if the child carries a hereditary disease. But since we don’t do these hemostasis tests systematically, we end up with deaths.
I remember, not so long ago, a family living in the south of the country had two twins circumcised on the same day. Unfortunately, they died two days later. However, there was no history of hemophilia. Parents learned, too late, that their children had it. Hence the importance of early diagnosis.
- -Can a known hemophiliac be circumcised without endangering his life?
Once the child is diagnosed with hemophilia, there is no problem. Because sometimes, we have diagnostic circumstances that are really very early. It is possible that the child had jaundice or had an illness that was suspected during the sample. And since the sample was done incorrectly, the child will have bruises.
Once the parents are alerted, especially if it is a newborn whose bleeding has lasted a long time, we consider diagnosing hemophilia. Once the family has been notified, the child is prepared for circumcision. He has his own doctor, whether he is a pediatrician or hematologist. He will also be prepared to undergo the operation outside of the heat period so as not to intensify the bleeding.
We therefore think about circumcising him in winter for example or, if he is of school age, during school holidays. Once the clotting factors are prepared, the circumcision can be planned by the surgeon, hematologist or pediatrician. In this way, the family is reassured, because we will be able to operate on the child in the best conditions.
Knowing that circumcision is a surgical procedure, we must prepare the entire technical platform. This is why the instruction from the Ministry of Health made circumcision mandatory in an operating room. A resuscitator and a surgeon will therefore be present. And in the case of a child with hemophilia, whether he is already diagnosed, because there is a family history, or we were alerted at birth, the child is prepared.
So, at a very specific age, from two years old, we can schedule circumcision. Finally, circumcision being a social obligation, we cannot deprive children with hemophilia of this act.
The only condition is that doctors must carry out a hemostasis assessment before the surgical procedure, because as minimal as it is, its consequences can be unfortunate if there is a diagnosis of hemophilia. And if we can postpone the operation and not do the circumcision very early, it is even better, because we will be able to carry out the necessary assessments to detect any disease in the child.
- Do you recommend against collective circumcisions during Ramadan?
Collective circumcisions during the 27th day of Ramadan are also a new phenomenon. I don’t see the point, especially since it has no religious benefit.
Circumcision can be done all year round by taking the necessary precautions and celebrating on the night of the 27th day. However, I think that this day should be avoided since the majority of parents want to do it on this day. Hospitals are therefore overwhelmed.
Awareness campaign against the risk of circumcision among hemophiliacs available on the website www.elwatan-dz.com
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