title: Uneventful cesarean delivery with administration of factor XI concentrate in a patient with severe factor XI deficiency.
abstract: Factor XI (FXI) is a procoagulant factor and antifibrinolytic agent, and its absence causes a bleeding tendency. FXI deficiency is autosomal in inheritance, with severe FXI deficiency in homozygotes and partial deficiency in heterozygotes. A 24-year-old primigravida with an uneventful pregnancy and no history of bleeding manifestations was admitted to our department at 38 weeks of gestation. Her blood count and serum biochemistry findings were normal except for a coagulation screen, which revealed a prolonged activated partial thromboplastin time (APTT) of 63 seconds (normal range, 24-35 seconds). The measured FXI coagulant activity of 8 IU/dL (reference range, 70-150 IU/dL) established a diagnosis of severe FXI deficiency. The breech presentation of the fetus prompted the decision for cesarean delivery under general anesthesia. We administered a single dose of FXI concentrate (15 IU/kg), which corrected the APTT to 34 seconds. The cesarean delivery was uncomplicated, and postpartum recovery of the mother and her baby was uneventful with no bleeding complications. The finding of an isolated prolonged APTT should prompt obstetricians to consider FXI deficiency. The appropriate use of factor FXI concentrate in managing obstetric patients with FXI deficiency can minimize potential bleeding complications and ensure an optimal outcome for both mother and neonate.
authors.affiliation: Second Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki, Greece.
authors.forename: Georgios
authors.initials: G
authors.lastname: Mavromatidis
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Dinas
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Delkos
authors.forename: Fotios
authors.initials: F
authors.lastname: Goutzioulis
authors.forename: Christos
authors.initials: C
authors.lastname: Vosnakis
authors.forename: Emmanouel
authors.initials: E
authors.lastname: Hatzipantelis
authors.forename: Vassilia
authors.initials: V
authors.lastname: Garipidou
authors.forename: David
authors.initials: D
authors.lastname: Rousso
mesh_terms: D000328:Adult; D016063:Blood Loss, Surgical / Q000517:prevention & control; D002585:Cesarean Section; D005172:Factor XI / Q000008:administration & dosage* / Q000032:analysis; D005173:Factor XI Deficiency / Q000097:blood / Q000188:drug therapy*; D005260:Female; D006470:Hemorrhage / Q000097:blood / Q000517:prevention & control; D006801:Humans; D050498:Live Birth; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic / Q000097:blood / Q000188:drug therapy*
chemical_list: D005172:Factor XI