Vitamin K deficiency bleeding and early infant male circumcision in Africa

Obstet Gynecol. 2013 Aug;122(2 Pt 2):503-505. doi: 10.1097/AOG.0b013e31828b2f5c.


Background: Early infant (1-60 days of life) male circumcision is being trialed in Africa as a human immunodeficiency virus prevention strategy. Postcircumcision bleeding is particularly concerning where most infants are breastfed, and thus these infants are at increased risk of vitamin K deficiency bleeding.

Case: During a circumcision trial, one infant bled for 90 minutes postprocedure. After discovering he had not received standard prophylactic vitamin K, we gave 2 mg phytomenadione (vitamin K1) intramuscularly; bleeding stopped within 30 minutes.

Conclusion: Vitamin K's extremely rapid action is not commonly appreciated. Neonatal vitamin K has been shown to be cost-effective. To increase availability and promote awareness of its importance, especially in low-resource settings where blood products and transfusions are limited, vitamin K should be included in the World Health Organization's Model List of Essential Medicines for Children.

Publication types

  • Case Reports
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Africa
  • Circumcision, Male / adverse effects*
  • Hemorrhage / drug therapy*
  • Hemorrhage / etiology
  • Hemorrhage / prevention & control
  • Humans
  • Infant, Newborn
  • Male
  • Vitamin K 1 / therapeutic use*
  • Vitamin K Deficiency / complications*
  • Vitamins / therapeutic use*


  • Vitamins
  • Vitamin K 1