Acquired factor XIII deficiency in two patients with bleeding events during veno-venous extracorporeal membrane oxygenation treatment

Abstract

We report two cases of acquired factor XIII deficiency with bleeding events during veno-venous extracorporeal membrane oxygenation (ECMO). Case 1: A 76-year-old man diagnosed with aspiration pneumonia after near-drowning was started on ECMO. Later, the patient presented with hemoptysis and anemia. Blood tests showed a decreased factor XIII activity of 29%. Although the patient recovered after receiving 1200 International Units of factor XIII concentrate, the patient had another episode of decreased factor XIII activity and bloody stool and was treated again with factor XIII concentrate. Case 2: A 48-year-old female diagnosed with pneumonia was started on ECMO. Soon after, she presented with hemoptysis and anemia. Blood tests showed a decreased factor XIII activity of 39%. The patient was treated with 720 IU of factor XIII concentrate with good recovery. Acquired factor XIII deficiency cannot be detected by routine coagulation tests, therefore it may be under-diagnosed in the ICU. Detection of acquired factor XIII deficiency is essential when treating a bleeding ECMO patient.

Factor XIII Activity Might Already Be Impaired before Veno-Venous ECMO in ARDS Patients: A Prospective, Observational Single-Center Cohort Study

“…Patients were either placed on ECMO in the referral hospital and retrieved on ECMO or transported to the ARDS center and eventually placed on ECMO, if conservative treatment failed. Venous access was established percutaneously using the right femoral vein for blood outflow (21)(22)(23)(24)(25) Fr lumen Cannulae, Maquet Critical Care, Solna, Sweden) and the right internal jugular vein (17-23 Fr) for return flow. vvECMO was established with conventional systems (ROTAFLOW ® or CARDIOHELP ® system with Quadrox-D ® oxygenator/HLS/PLS, Maquet Critical Care, Solna, Sweden), and the ECMO circuit was primed with saline and connected via a biocoated tubing set.…”

“…In particular, F XIII can only be indirectly assessed by POC methods. An acquired F XIII deficiency can be associated with major complications such as surgical re-exploration in critically ill patients, putting the need for a routine monitoring of F XIII activity in intensive care medicine more in focus [ 19 , 20 , 21 ].…”

Acquired Factor XIII Deficiency Is Common during ECMO Therapy and Associated with Major Bleeding Events and Transfusion Requirements

“…Factor XIII deficiency has been associated with delayed haemorrhagic complications and the need for surgical re-exploration following cardiac surgery as well as bleeding complications in neurosurgical patients and high morbidity in both medical and surgical populations [ 21 , 22 , 23 , 24 ]. Acquired factor XIII deficiency has been reported during ECMO therapy in small populations of adults and children [ 14 , 25 , 26 , 27 ]. However, no study has so far evaluated the association between the rate and severity of factor XIII deficiency, major bleeding and transfusion needs during ECMO therapy.…”