Hemorrhagic Shock after Neonatal Circumcision: Severe Congenital Factor XIII Deficiency

Table 1

Chronology of care.

Event	Day of life (DOL) and time
Birth	DOL 1 at 1:16 am
Vitamin K administered	DOL 1 at 8:26 am
Circumcision performed	DOL 1 at 11:52 am
Bleeding noted from circumcision	DOL 1 at 2:55 pm, 3:10 pm and 7:00 pm; unknown timing of silver nitrate application
Labs checked (Hgb 15.2 g/dL)	DOL 2 at 3:55 am
Discharged to home	DOL 2 at 4:56 pm
First visit to ER	DOL 3 at 1:11 am
Second visit to ER	DOL 3 at 4:33 am
Third visit to ER (Hgb 12.5 g/dL)	DOL 3 at 2:25 pm
Fourth visit to ER (Hgb 3.4 g/dL)	DOL 4 at 12:35 pm