Tattooing, piercing and inherited coagulation disorders

Abstract

I read with great interest the article by Khair et al. regarding their experience of young women with inherited bleeding disorders (IBD) 1. To my knowledge, they are the first to stress the rising issue related to body-art practices risk, and more precisely, the appreciation of such risks by the patients. The young patients with IBD join those with congenital heart conditions 2 and those with a disease – or drug – induced immunosuppression 3 with regards to body art. They need to be informed of the risks beforehand and seek advice from their physician to know whether such body art procedure is advisable and, if so, under which conditions and when it can optimally be done. According to Khair et al., having an IBD did not prevent half of the respondents of this study to get tattooed or pierced 1. It would have been highly valuable to know whether those who underwent such procedures did or did not develop a severe bleeding after the procedure. We have to admit that currently the medical literature is non-existent on this particular topic and physicians, as well as patients, are usually inspired by their own opinion on the matter or by the information collected on the Internet. However, one should keep in mind that piercing and tattooing are absolutely two different procedures that carry different bleeding risks. Body piercing is usually performed using a hollow 12–18 gauge needle that is passed through the body part and body jewellery inserted in the hole. Bleeding is a very common side effect and can be substantial in certain sites. Antoszweski et al. found an overall prevalence of 12.3% of bleeding in their pierced population 4. Oral piercing appears to have the highest risk, as minor bleeding has been reported within the 12 h after piercing in 90% of individuals 5. To the best of my knowledge, only one case of bleeding, that necessitated application of tranexamic acid in an emergency ward, was reported in a male patient with haemophilia after nipple piercing 6. Several, but hopefully rare, cases of severe bleeding after piercing in patients with no IBD plead for avoiding body piercing in IBD patients 7-9. Tattooing is characterized by the introduction of pigments in the dermis through the epidermis by puncturing the skin. A slight transient bleeding occurs during the procedure because of the puncture of papillary dermis. A non-compressive purpuric ecchymosis under the tattoo is rare, but possible in some cases 10. However, no case of cataclysmic bleeding or compressive haematoma after tattooing has been reported thus far. I have the personal experience of caring not only for a patient with von Willebrand's disease who underwent two tattoos with no severe haemorrhagic complication but also of patients being refused tattoos 'systematically' because of an IBD. On the Internet, it is a widely spread and accepted fact that tattoos are contraindicated for patients with IBD. To my point of view, it remains debatable to systematically exclude tattooing to such patients. As written by Khair et al., some patients may feel 'different' because they (think they) cannot get tattooed 1. For some individuals, tattooing has a positive effect on ego bolstering that could take part in a coping strategy as seen in diabetic patients, in a different setting. It is therefore nowadays important that: (i) health care providers (nurses and physicians) understand the medical issues associated with body-art procedures (tattooing and piercing), have a non-judgmental approach and be able to inform correctly the patients about the risks; (ii) patients should discuss with their physician about their wish to get tattooed or pierced; (iii) tattoo artists and piercers should systematically delay the procedure and refer such patients to their physicians, (iv) these patients must be considered for prophylactic treatment before such a procedure and (v) it would be valuable to obtain from individuals with IBD, who got pierced or tattooed, about their clinical feedback in terms of bleeding intensity, haematoma, etc. to assess the real risk of body art in IBD patients. The author wishes to thank Scott DeBoer, RN, MSN, CEN, CCRN, CFRN (Peds-R-Us Medical Education) for text editing. The author designed, wrote and drafted the manuscript. The author stated that he had no interests which might be perceived as posing a conflict or bias.

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