title: Airway Compromise and Perioperative Management of a Patient with Acquired Factor XIII Inhibitor.
abstract: Perioral hematomas can lead to acute airway compromise and can present significant challenges in both direct and indirect approaches to airway instrumentation. In patients with normal cell counts and routine coagulation tests, spontaneous hematomas are rare, but when encountered, they elicit a limited differential diagnosis that includes von Willebrand factor deficiency, platelet dysfunction, and the acquired factor XIII (FXIII) deficiency. Although spontaneous hematoma formation resulting from FXIII inhibition has been reported, we describe what may be the first reported case of FXIII inhibitor-related hematoma leading to acute airway compromise. Successful management of this patient required multidisciplinary cooperation among anesthesiologists, intensivists, otolaryngologists, and hematologists.
authors.affiliation: From the *Department of Anesthesiology, University of Ottawa, Ottawa, Ontario, Canada; Departments of †Anesthesiology, ‡Otolaryngology and Head and Neck Surgery, University of Ottawa, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; §Division of Intensive Care, Department of Internal Medicine, University of Ottawa, Ottawa, Ontario, Canada; and ‖Division of Hematology, Department of Medicine, University of Ottawa, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
authors.forename: Kira
authors.initials: K
authors.lastname: Tone
authors.forename: Manoj
authors.initials: M
authors.lastname: Lalu
authors.forename: Shaun Jason
authors.initials: SJ
authors.lastname: Kilty
authors.forename: Erin
authors.initials: E
authors.lastname: Rosenberg
authors.forename: Alan
authors.initials: A
authors.lastname: Tinmouth
mesh_terms: D000369:Aged, 80 and over; D000402:Airway Obstruction / Q000175:diagnosis / Q000503:physiopathology* / Q000601:surgery; D003937:Diagnosis, Differential; D005176:Factor XIII / Q000037:antagonists & inhibitors* / Q000378:metabolism; D005177:Factor XIII Deficiency / Q000097:blood* / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000379:methods; D009060:Mouth Floor / Q000473:pathology; D019990:Perioperative Care / Q000379:methods; D014139:Tracheostomy / Q000379:methods; D016896:Treatment Outcome
chemical_list: D005176:Factor XIII