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'''Haemorrhage/bleeding''' is [a]n abnormal escape of blood from an artery, a vein, an arteriole, a venule or a capillary network. Haemorrhage may occur into a body cavity or organ, into tissues such as muscles, or externally by way of a wound. Internal haemorrhage often causes a HAEMATOMA. Severe haemorrhage results in dangerous loss of circulating blood volume and there may be insufficient to supply the heart muscle and the brain. This is inevitably fatal unless a rapid transfusion of blood is given. Insufficient circulating fluid causes the syndrome of surgical [[Shock| SHOCK]] for which fluid replacement is urgently needed. This need not be whole blood; an infusion of salt water (saline) can save life.<ref>{{REFweb
[[File:Bleeding finger.jpg|thumb|Bleeding wound in the finger<br>Other names: Hemorrhaging, haemorrhaging]]
'''Haemorrhage (bleeding)''' is [a]n abnormal escape of blood from an artery, a vein, an arteriole, a venule or a capillary network. Haemorrhage may occur into a body cavity or organ, into tissues such as muscles, or externally by way of a wound. Internal haemorrhage often causes a HAEMATOMA. Severe haemorrhage results in dangerous loss of circulating blood volume and there may be insufficient volume to supply the heart muscle and the brain. This is inevitably fatal unless a rapid transfusion of blood is given. Insufficient circulating fluid causes the syndrome of surgical [[Shock| SHOCK]] for which fluid replacement is urgently needed. This need not be whole blood; an infusion of salt water (saline) can save life.<ref>{{REFweb
  |url=https://medical-dictionary.thefreedictionary.com/H%c3%a6morrhage
  |url=https://medical-dictionary.thefreedictionary.com/H%c3%a6morrhage
|title=Haemorrhage
|publisher=The Free Dictionary
|date=2004
|accessdate=2022-01-20
}}</ref>
==Haemorrhage after circumcision==
Neonatal circumcision is an elective, medically-unnecessary, non-therapeutic [[amputation]] of the healthy [[foreskin]] that is done only after parents sign a [[circumcision consent form]]. It exposes an infant to surgical risks, but does not treat or prevent disease.<ref name="deacon2022">{{REFjournal
|last=Deacon
|first=Matthew
|init=M
|author-link=
|last2=Muir
|first2=Gordon
|init2=G
|author2-link=
|etal=no
|title=What is the medical evidence on non-therapeutic child circumcision?
|journal= Int J Impot Res
|date=2022-01-08
|url=https://www.nature.com/articles/s41443-021-00502-y
|pubmedID=34997197
|DOI=10.1038/s41443-021-00502-y
|accessdate=2022-02-01
}}</ref>
[[Circumcision]] is an [[Amputation| amputative]] surgical operation that severs arteries and veins as it amputates the [[foreskin]]. As with any surgical operation, haemorrhage is an expected complication of surgery.<ref name="kaplan1983">{{REFjournal
|last=Kaplan
|first=George W.
|init=GW
|author-link=George W. Kaplan
|title=Complications of circumcision
|journal=Urol Clin N Amer
|date=1983-08
|volume=10
|issue=3
|pages=543-9
|url=http://www.cirp.org/library/complications/kaplan/
|quote=
|pubmedID=6623741
|pubmedCID=
|DOI=
|accessdate=2022-01-20
}}</ref><ref name="williams-kapilla1993">{{REFjournal
|last=Williams
|init=N
|author-link=
|last2=Kapilla
|init2=L
|author2-link=
|etal=no
|title=Complications of circumcision.
|journal=Brit J Surg
|location=
|date=1993-10
|volume=80
|issue=10
|pages=1231-6
|url=http://www.cirp.org/library/complications/williams-kapila/
|quote=
|pubmedID=8242285
|pubmedCID=
|DOI=10.1002/bjs.1800801005
|accessdate=2022-01-20
}}</ref>
Strong haemorrhage after a circumcision of a boy was the trigger for the [[Cologne circumcision court judgment]] in 2012.
The clotting ability of the blood is ''not'' tested prior to non-therapeutic infant circumcision as it is thought be unnecessary.<ref>{{REFjournal
|last=Eroglu
|first=
|init=E
|author-link=
|last2=Sözmen
|first2=
|init2=BO
|author2-link=
|last3=Kayiran
|first3=
|init3=SN
|author3-link=
|etal=yes
|title=Evaluation of coagulation tests before newborn circumcision: is it necessary?
|trans-title=
|language=
|journal=Blood Coagul Fibrinolysis
|location=
|date=2016-03
|volume=27
|issue=2
|article=
|page=
|pages=
|url=https://journals.lww.com/bloodcoagulation/Abstract/2016/03000/Evaluation_of_coagulation_tests_before_newborn.10.aspx
|archived=
|quote=
|pubmedID=26523913
|pubmedCID=
|DOI=10.1097/MBC.0000000000000399
|accessdate=2022-02-01
}}</ref>
===Statistics===
Feinberg et al. (2010) collected data on 537 collective [[Gomco]] circumcisions. They found 24 bleeds (4.47%). Bleeding was significantly associated with lack of operator experience.<ref name="feinberg2010">{{REFjournal
|last=Feinberg
|first=Arthur N.
|init=
|author-link=
|last2=Brust
|first2=Rita A.
|init2=
|author2-link=
|last3=Walker
|first3=Travis A.
|init3=
|author3-link=
|etal=no
|title=Bleeding at Circumcision: Patient or Operator Issue?
|trans-title=
|language=
|journal=Clin Pediatr (Phila)
|location=
|date=2010-08
|volume=49
|issue=8
|article=
|page=
|pages=760-3
|url=https://journals.sagepub.com/doi/abs/10.1177/0009922810364658
  |archived=
  |archived=
  |title=Haemorrhage
|quote=
|pubmedID=20522619
|pubmedCID=
|DOI=10.1177/0009922810364658
|accessdate=2022-01-21
}}</ref>
 
Heras et al. (2018) collected data on 1,115 circumcisions. They found 41 complications (3.9%), all involving haemorrhage. Three patients required sutures.<ref name="heras2018">{{REFjournal
|last=Heras
|first=Andrea
|init=
|author-link=
|last2=Vallejo
|first2=Victoria
|init2=
|author2-link=
|last3=Pineda
|first3=Marcela L.
|init3=
|author3-link=
|last4=Jacobs
|first4=Allan J.
|init4=
|author4-link=
|last5=Cohen
|first5=Lourdes
|init5=
|author5-link=
|etal=no
  |title=Immediate Complications of Elective Newborn Circumcision
  |trans-title=
  |trans-title=
  |language=
  |language=
|journal=Hosp Pediatr
|location=
|date=2018-10
|volume=8
|issue=10
|article=
|page=
|pages=615-9
|url=https://publications.aap.org/hospitalpediatrics/article/8/10/615/26528/Immediate-Complications-of-Elective-Newborn
|archived=
|quote=
|pubmedID=30262594
|pubmedCID=
|DOI=10.1542/hpeds.2018-0005
|accessdate=2022-01-21
}}</ref>
Litwiller et al. (2018) collected data on 260 circumcisions using the [[Gomco]] clamp. They compared statistics of circumcisions of newborn infants from the normal newborn nursery (NNN) with those from the Newborn Intensive Care Unit (NICU). They found a bleeding rate of 9.6% among neonates from the NNN, but a bleeding rate of 22% among neonates from the NICU.<ref name="litwiller2018">{{REFjournal
|last=Litwiller
|first=Abigail R.
|init=
|author-link=
|last2=Browne
|first2=Courtney
|init2=
|author2-link=
|last3=Haas
|first3=David M.
|init3=
|author3-link=
|etal=no
|title=Circumcision bleeding complications: neonatal intensive care infants compared to those in the normal newborn nursery
|journal=J Matern Fetal Neonatal Med
|location=
|date=2018-06
|volume=31
|issue=11
|article=
|page=
|pages=1513-6
|url=https://www.tandfonline.com/doi/abs/10.1080/14767058.2017.1319931
|archived=
|quote=
|pubmedID=28412847
|pubmedCID=
|DOI=10.1080/14767058.2017.1319931
|accessdate=2022-01-21
}}</ref>
===Deaths===
No one collects statistics on circumcision deaths. The number of boys who die from hemorrhage after [[circumcision]] is unknown. Some have been reported. Some examples are set forth below.
* Julius Katzenstein: 8-days-old, bled to death after circumcision, 14 December 1856, New York, NY, USA.
* Myer Jacob Levy: 8-days-old, bled to death after circumcision, 18 April 1858, New York, NY, USA.
* Michael Julian Baldwin: infant boy, 4-days-old, hemorrhage after circumcision. 21 August 1927, Monroe County, Indiana, USA.
* Boma Oruitemeka: Death by circumcision, severe hemorrhage. 1990, London, England, UK.
* Demetrius Manker bled to death in 1993 after circumcision in Dade County, Florida.<ref>{{REFnews
|title=Baby bleeds to death after circumcision
|url=http://www.cirp.org/news/1993.06.21_death/
  |last=
  |last=
  |first=
  |first=
|init=
  |author-link=
  |author-link=
  |publisher=The Free Dictionary
|last2=
|init2=
|author2-link=
  |publisher=Miami Herald
  |website=
  |website=
  |date=2004
  |date=1993-06-26
  |accessdate=2022-01-20
|accessdate=2022-01-21
|quote=
}}</ref>
* Hiss et al. (2000) reported the death of an infant from haemorrhage following ritual circumcision in [[Israel]].<ref name="hiss2000">{{REFjournal
|last=Hiss
|first=
|init=J
|author-link=
|last2=horowitz
|first2=
|init2=A
|author2-link=
|last3=Kahana
|first3=
|init3=T
|author3-link=
|etal=no
|title=Fatal haemorrhage following male ritual circumcision
|journal= J Clin Forensic Med
|location=
|date=2000-03
|volume=7
|issue=1
|article=
|page=
|pages=32-4
|url=http://www.cirp.org/library/death/hiss1/
|archived=
|quote=
|pubmedID=15274991
|pubmedCID=
|DOI=10.1054/jcfm.1999.0340
  |accessdate=2022-01-21
}}</ref>
* Ryleigh McWillis died from blood loss after circumcision in British Columbia in 2002.<ref>{{REFdocument
|title=Judgement of Inquiry Into the Death of McWillis[,] Ryleigh Roman Bryan
|url=http://www.circumstitions.com/death-exsang.html
|contribution=
|last=Newell
|first=Chico
|publisher=Office of the Chief Coroner
  |format=
  |format=
|date=2004-01-19
|accessdate=2022-01-21
}}</ref>
* Ryan Heydari bled to death in Ontario after circumcision in 2015.<ref name="blackwell2015">{{REFnews
|title=Ontario newborn bleeds to death after family doctor persuades parents to get him circumcised
|url=https://nationalpost.com/health/ontario-newborn-bleeds-to-death-after-family-doctor-persuades-parents-to-get-him-circumcised
|last=Blackwell
|first=Tom
|coauthors=
|publisher=National Post
|website=
|date=2015-10-25
|accessdate=2022-01-21
  |quote=
  |quote=
}}</ref>
}}</ref>
* "Baby R" died on 24 January 2022 at [https://www.texaschildrens.org/ Texas Children's Hospital] following a brain haemorrhage after [[circumcision]].
{{SEEALSO}}
* [[Bleeding]]
* [[Blood loss danger to infants]]
* [[Death]]
* [[Penile haematoma]]


{{REF}}
{{REF}}


[[Category:Term]]
[[Category:Medical term]]
[[Category:Circumcision complication]]
[[Category:Circumcision complication]]
[[Category:Circumcision risk]]
[[de:Hämorrhage]]
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