Incidental diagnosis of haemophilia: A case report of three cases following voluntary medical male circumcision in South Africa

Introduction: Since 2007, over 15.2 million Voluntary Medical Male Circumcisions (VMMCs) have been performed in 14 sub-Saharan African countries for partial prevention of transmission of HIV. In South Africa, close to 4 million VMMCs have been conducted since the onset of the national VMMC program in 2010. Within this context, the occurrence of notifiable adverse events related to peri-operative bleeding occurs commonly. The ability to screen, diagnose, and manage these cases appropriately will mitigate associated adverse events. Aim: In this paper, we describe three cases of prolonged bleeding after VMMC procedure and propose program measures. Methods: Descriptive haemophilia case accrual at three sites implementing a PEPFAR- funded VMMC program. The cases were recruited consecutively over a 17-month period (May 2017 to September 2018). Standard laboratory tests were used to confirm diagnosis. Written assent and informed consent were obtained from each subject and their respective guardians. Results: A total number of 31 severe or moderate adverse events were reported of whom three 16-year-old clients from three different provinces in South Africa were diagnosed with Haemophilia post VMMC services during July 2018. Two clients were diagnosed with Haemophilia A and one client was diagnosed with Haemophilia B. Conclusions: Greater emphasis on training and placement of qualified health care workers for peri-operative screening as well as a high index of suspicion for pre-operative diagnosis and appropriate referral for bleeding disorders is highly recommended. Clinical VMMC protocols guiding post-operative wound management, adverse event management, active client follow-up and care need to be reinforced, with rigorous reporting. Keywords: Prolonged bleeding; Adverse events; Haemophilia; Screening; Bleeding disorders; Incidental diagnosis.