title: Perioperative course of FXIII in children undergoing major surgery.
abstract: BACKGROUND
  Acquired deficiency of FXIII because of perioperative hemodilution has been described several times in adults; however, data in children are scarce. We performed a prospective observational trial to evaluate the intraoperative course of FXIII in children undergoing elective major surgery.
  
  
  METHODS
  Blood samples were repeatedly taken from 46 children aged 0.3-16 years undergoing major surgery. Concentrations of FXIII and fibrinogen, thrombelastometry by ROTEM®, and cell count were assessed intraoperatively.
  
  
  RESULTS
  A significant decrease in FXIII concentration (median 60%; IQR 49-69%) was already noted at beginning of surgical procedures, while most ROTEM® traces remain unchanged. FXIII levels further deteriorated intraoperatively to minimal levels of 33% (15-61%). Lowest intraoperative clot strength (ExTEM) was 44 mm (34-50 mm), and fibrinogen plasma levels decreased to minimal levels of 130 mg·dl(-1) (95-160 mg·dl(-1) ). In 43 of 46 children, transfusion therapy was necessary. Despite of transfusion of fresh frozen plasma (cumulative total dose 22 ml·kg(-1) [11-32 ml·kg(-1) ]) in 21 of 46 children, FXIII level remains low in all children till the end of surgery at levels of 39% (20-46%).
  
  
  CONCLUSIONS
  Coagulation factor XIII decreased early during major surgery owing to hemodilution. Overall intraoperative FXIII levels remain low despite of transfusion of fresh frozen plasma.
authors.affiliation: Department of Anaesthesia, University Children's Hospital Zurich, Steinwiesstrasse 75, Zurich, Switzerland. thorsten.haas@kispi.uzh.ch
authors.forename: Thorsten
authors.initials: T
authors.lastname: Haas
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Korte
authors.forename: Nelly
authors.initials: N
authors.lastname: Spielmann
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Mauch
authors.forename: Caveh
authors.initials: C
authors.lastname: Madjdpour
authors.forename: Markus
authors.initials: M
authors.lastname: Schmugge
authors.forename: Markus
authors.initials: M
authors.lastname: Weiss
mesh_terms: D000293:Adolescent; D001772:Blood Cell Count; D001780:Blood Coagulation Tests; D001803:Blood Transfusion / Q000706:statistics & numerical data; D002648:Child; D002675:Child, Preschool; D017558:Elective Surgical Procedures; D005177:Factor XIII Deficiency / Q000453:epidemiology* / Q000209:etiology*; D005260:Female; D005340:Fibrinogen / Q000032:analysis; D005440:Fluid Therapy; D006438:Hemodilution / Q000009:adverse effects; D006454:Hemoglobins / Q000032:analysis; D006487:Hemostasis; D006801:Humans; D007223:Infant; D019934:International Normalized Ratio; D007431:Intraoperative Complications / Q000097:blood / Q000453:epidemiology / Q000209:etiology; D008297:Male; D059035:Perioperative Period; D010952:Plasma Substitutes / Q000627:therapeutic use; D010976:Platelet Count; D011183:Postoperative Complications / Q000097:blood / Q000453:epidemiology / Q000209:etiology; D011446:Prospective Studies; D013514:Surgical Procedures, Operative; D013916:Thrombelastography
chemical_list: D006454:Hemoglobins; D010952:Plasma Substitutes; D005340:Fibrinogen