title: Postoperative bleeding in a patient with normal screening coagulation tests.
abstract: A 54-year-old man was brought to the emergency room after a head-on collision. He had multiple fractures in his lower extremities and required immediate surgery. After surgery, the patient had a persistent drop in hemoglobin, hematocrit and platelets despite red blood cell transfusions. Laboratory studies included normal prothrombin time, activated partial thromboplastin time, normal plasminogen functional activity, negative antiplatelet antibodies, normal platelet functional analysis and negative disseminated intravascular coagulation screen. Factor XIII antigen levels were 25% of predicted, and the diagnosis of factor XIII deficiency was made. The patient was treated with cryoprecipitate, and the bleeding stopped. Patients with factor XIII deficiency have either a rare congenital or acquired coagulation disorder. Both presentations have normal standard laboratory clotting tests, and the diagnosis requires an assay measuring factor XIII activity or antigen levels. The usual treatment includes cryoprecipitate, fresh-frozen plasma or recombinant factor XIII. This deficiency should be considered in patients with unexplained spontaneous, traumatic or postoperative bleeding.
authors.affiliation: Texas Tech University Health Sciences Center, Lubbock, Texas 79416, USA. eva.nourbakhsh@ttuhsc.edu
authors.forename: Eva
authors.initials: E
authors.lastname: Nourbakhsh
authors.forename: Reza
authors.initials: R
authors.lastname: Anvari
authors.forename: Nicholas
authors.initials: N
authors.lastname: D'cunha
authors.forename: Lauren
authors.initials: L
authors.lastname: Thaxton
authors.forename: Asim
authors.initials: A
authors.lastname: Malik
authors.forename: Kenneth
authors.initials: K
authors.lastname: Nugent
mesh_terms: D001780:Blood Coagulation Tests; D005169:Factor VIII / Q000627:therapeutic use; D005177:Factor XIII Deficiency / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D005340:Fibrinogen / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000097:blood / Q000188:drug therapy / Q000209:etiology*
chemical_list: C026912:cryoprecipitate coagulum; D005169:Factor VIII; D005340:Fibrinogen