Asia Pacific Journal of Pediatric and Child Health

Abstract Ref Number = APCP943

Poster Presentation

CIRCUMCISION IN PEOPLE WITH HEMOPHILIA USING YOGYAKARTA METHOD

Pudjo HagungWidjajanto,Agus Wibowo,Ivan Onggo Saputro,Nur Budiono,Nurul Hadi,Agus Tusino Division of Hematology and Oncology Dr Sardjito Hospital Faculty of Medicine Public Health and Nursing Universitas Gadjah Mada Yogyakarta Indonesian Hemophilia Society Yogyakarta Chapter Department of Urology, Dr S Hardjolukito National Air Force Hospital, Yogyakarta Pediatric Department, Dr Tjitrowardojo District Hospital of Purworejo, Central Java Pediatric Department, Dr Soedirman District Hospital of Kebumen, Central Java

Background : Circumcision is one of the most common surgery in boys, especially in the moslem community. There is a situation where doctors tend to avoid this procedure due to bleeding problems. In 2007 we developed the protocols of anti-hemophilic factor (AHF) administration for circumcision in people with hemophilia (PWH) namely “Yogyakarta method”. This study was aimed to evaluate the outcomes of this protocol. Material : This was a retrospective study based on medical record of PWH who underwent circumcision in Dr. Sardjito Hospital, Yogyakarta (DSH) and 3 surrounding hospitals under supervision from DSH during 2007-2017. The diagnosis of hemophilia were based on clinical findings and factor assay. PWHs were received 2 doses of factor VIII 25 IU/kg in hemophilia A or factor IX 50 U/kg in hemophilia B, each plus tranexamic acid 15 mg/kg at 30 minutes before and during circumcision. The same doses were administered every 12 hours and 24 hours in hemophilia A and B, respectively, after circumcision till the wound perfectly recovered. Circumcision was performed by pediatric surgeon or urologist. Informed consent was obtained from parents. Results : Of 33 circumcisions, 12 were done in DSH, 16 in Airforce Hospital, 2 in district hospital of Kebumen and 3 PWH in Purworejo District Hospital. PWH with hemophilia A were 31 (94%) and hemophilia B 2 (6%) patients. The severity were mild in 10 (30,3%), moderate 15 (45,5%), and severe 8 (24,2%). Median age at procedure was 12 (6-29) years. Mean of AHF consumption was 202 ± 18 U/kg with median length of stay was 4 (1-11) days. No serious bleeding were found during and after circumcision in all PWHs. No other complications were found. Conclusions : The Yogyakarta method were safe and sufficient to control the bleeding in circumcision of PWHs. This method is also suitable for district hospital setting

Keywords: hemophilia Circumcision Anti-hemophillic factor