SACRAMENTO: Another circumcision death

March 8, 2013

Another circumcision death

An 11-day-old boy has died died at UC Davis Children's Hospital in Sacramento, California, two days after being circumcised in the nearby town of Lodi.

According to his grandfather, Brayden Tyler Frazier had been taken to the doctor when he was a week old because he had been sleeping constantly and not eating. His parents had also noticed that his neonatal sticks and pricks had not healed quickly, and had to stay bandaged for two days or more.

The doctor in Lodi sent them home with instructions to monitor his condition and after two days, he was circumcised. It was later discovered that the wound had continued to bleed. He was taken back to the doctor, then to Urgent Care, then to the ER, and then transferred to UC Davis Medical.
He had "generalized bleeding" and an unidentified infection.

Over the two days after his circumcision, he went into seizures and a coma, and died.

A paediatric haematologist/oncologist comments:

Coagulation studies are not routinely done before many types of surgeries, including circumcisions. ... Also coagulation studies are not a part of routine newborn screening tests. Coagulation is complex, and involves the platelet cell and a couple dozen chemicals / proteins, to clot when needed but also not to clot in inappropriate locations, or excessively, and to additionally reabsorb clots after they have done their jobs. Plus hemophilia isn't a single disorder; there are two main types of "hemophilia" (deficiency of Factor 8 or Factor 9 ). But there are many other reasons to bleed excessively. However, a combination of several functional tests can narrow down the list of specific aspects of the coagulation system that need testing, in a given individual whose screening functional tests are abnormal, in order to identify what needs to be done to treat that individual's bleeding/risk. However it is more complicated in newborns: 1) Of the couple dozen chemicals, many are in different levels in newborns. For several reasons, some aspects of the newborn's system are hypo-coagulable [blood won't clot] while others are hyper-coagulable [blood clots very easily] and it generally balances out. So there are different normal ranges for results in infants. 2) Most tests of the coagulation system involve drawing blood from a vein or artery and simultaneously mixing it with anticoagulants (different anticoagulants for different tests). These tests also involve a relatively large amount of blood. Additionally the tissue factors, that trigger the initiation of the clotting system in injuries, are released from a heel stick and affect clotting studies. 3) It is however easy to do extensive or specific coagulation tests in newborns. When planned, the blood is correctly drawn at delivery from the umbilical cord, taking the blood otherwise left in the placenta... This can be planned when a family history [of haemophila] is present or there are other reasons to test. Surgeries / procedures that have no medical necessity, [such as] circumcision, should not be done.