[size=20px]You are spending two weeks in Kenya volunteering in a rural hospital. You have just performed a Gomco clamp circumcision on a two day old full term male infant.

 

There is excessive bleeding that is recalcitrant to pressure for one hour. The most likely reason for bleeding is

 

A human immunodeficiency virus infection.

 

B vitamin K deficiency.

 

C thrombocytopenia.

 

D disseminated intravascular coagulopathy.

 

E malaria.[/size]

(Untitled)

 

b

b

correct

 

Neonatal coagulopathy, especially in preterm infants, has been extensively studied and differences between neonates and older children are well defined. Circumcision is being performed more aggressively in sub-Saharan Africa in an attempt to decrease HIV transmission. The routine use of vitamin K is variable in this region and infants who are only receiving breast milk are at risk for vitamin K deficiency. In the setting of surgical bleeding due to vitamin K deficiency giving a dose of vitamin K can reverse the bleeding in as little as thirty minutes.

 

In experienced hands, the Gomco clamp device is very safe and has a low rate of complications.

 

Thrombocytopenia is common in an ill neonate and is most commonly associated with sepsis. Likewise neonatal DIC is typically found in a clearly ill infant. Maternally transmitted malaria occurs in endemic areas at an incidence of three to five perent. Though infected infants have a wide range of symptoms, ranging from mild jaundice to severe illness, bleeding diathesis is not typical.