Neonatal Nurse Practitioner Practice Exam

What is the most likely cause of persistent bleeding in a 2-day-old male after circumcision?

1. Factor VIII deficiency

2. Factor V deficiency

3. Poor technique

4. Vitamin K deficiency

The correct answer is: Factor VIII deficiency

In the context of persistent bleeding after circumcision in a 2-day-old male, the most likely cause is factor VIII deficiency, which is a form of hemophilia. Hemophilia A, caused by a deficiency in factor VIII, leads to a propensity for bleeding due to the impaired ability of blood to clot. Since circumcision is a procedure that involves cutting the skin, the demand for effective clotting is heightened. In newborns, especially those who have not yet received Vitamin K supplementation, a deficiency in clotting factors can manifest more prominently after surgical procedures. While factor V deficiency could also lead to bleeding issues, it is less commonly associated with this specific scenario compared to factor VIII deficiency. Poor technique might contribute to bleeding, but it would likely be an isolated incident rather than a persistent issue, and vitamin K deficiency typically would be more relevant to conditions that result in generalized bleeding rather than a specific acute bleeding event post-circumcision. In this case, the surgical intervention reveals the underlying coagulation issue, making factor VIII deficiency the most plausible explanation for the observed persistent bleeding.