title: Anesthetic strategy for cesarean section in a patient with factor XI deficiency. Case report.
abstract: OBJECTIVE
  Factor XI deficiency is a rare hematologic disorder. Hemophilia C (factor XI deficiency) affects both genders and it is usually asymptomatic, manifesting only as postoperative hemorrhage. It is an autosomal recessive, homozygous or heterozygous, disorder, and its severity depends on the levels of factor XI. The objective of this report was to present the anesthetic strategy in a patient with hemophilia C.
  
  
  METHODS
  This is a 32 years old female, gravida 1/para 0, on the 39th week of pregnancy, scheduled for elective cesarean section. Physical and laboratorial exams did not show any abnormalities. According to the recommendations of the hematologist, on the day of the procedure, the patient was given promethazine, 25 mg, hydrocortisone, 500 mg, due to prior transfusion reaction, and plasma, 10 mL x kg(-1) for a total of 700 mL. Two hours later, the patient underwent subarachnoid block under routine monitoring. Ringer's lactate, 2000 mL, was administered for hydration. The anesthetic-surgical procedure proceeded without intercurrences. Postoperatively, the patient was doing well when, on the 3rd PO day, fresh frozen plasma (FFP), 10 mL x kg(-1), was administered to prevent late postoperative bleeding.
  
  
  CONCLUSIONS
  The objective of this report was to present the anesthetic protocol for patients with hemophilia C and to alert for the need of investigation in patients with a history of postoperative bleeding, when a coagulation study should e be done before any invasive procedure and, in the case of prolonged aPTT, one should investigate the presence of factor XI deficiency.
authors.affiliation: Universidade Estadual Paulista Júlio de Mesquita Filho.
authors.forename: Norma Sueli P
authors.initials: NS
authors.lastname: Módolo
authors.forename: Vera Lucia Fernandes
authors.initials: VL
authors.lastname: de Azevedo
authors.forename: Paulo Sérgio S
authors.initials: PS
authors.lastname: Santos
authors.forename: Márcia Leal
authors.initials: ML
authors.lastname: Rosa
authors.forename: Dina Rita
authors.initials: DR
authors.lastname: Corvino
authors.forename: Lucas Jorge S Castro
authors.initials: LJ
authors.lastname: Alves
mesh_terms: D000328:Adult; D000773:Anesthesia, Obstetrical / Q000379:methods*; D002585:Cesarean Section; D005173:Factor XI Deficiency; D005260:Female; D006801:Humans; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic