Postoperative Bleeding in a Patient With Normal Screening Coagulation Tests

Nourbakhsh, Eva; Anvari, Reza; D’Cunha, Nicholas; Thaxton, Lauren; Malik, Asim; Nugent, Kenneth

doi:10.1097/maj.0b013e3182246109

Cited by 5 publications

(5 citation statements)

References 12 publications

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“…El déficit de este factor es una patología poco frecuente y que se encuentra infradiagnosticada debido a que sus niveles plasmáticos no se evalúan en las pruebas de coagulación rutinarias. De este modo, si existe sospecha de dicha patología, hay que realizar pruebas específicas que nos muestren los niveles de F. XIII en sangre 4 .…”

Section: Discussionunclassified

“…En este campo, Nourbakhsh y cols. defienden la posibilidad de administrar de 20 a 70 U/kg/mes de concentrado de factor XIII 4 , mientras que Lim y cols. optan por una dosis preoperatoria de 2500 U (42 U/kg) 9 .…”

Section: Discussionunclassified

“…El déficit del F. XIII de la coagulación puede deberse a causas congénitas o a causas adquiridas. La enfermedad congénita se hereda de forma autosómica recesiva y su incidencia se sitúa en torno a 1-1,5/1.000.000 4 . Esta forma se caracteriza por grandes sangrados desde el nacimiento.…”

Section: Introductionunclassified

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Déficit adquirido de Factor XIII como causa de hemorragia masiva con compromiso de vía aérea superior en cirugía oncológica de cavidad oral

Saez-Torres¹,

Fidalgo²,

Cobo³

et al. 2023

j.maxilo

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El diagnóstico etiológico de una hemorragia postoperatoria persistente en pacientes adultos sin antecedentes médicos de interés supone un reto a día de hoy. Dentro de las distintas causas encontramos el déficit adquirido del Factor XIII (F. XIII) de la coagulación. El déficit de este factor suele pasar desapercibido al no ser valorado en el estudio preoperatorio rutinario.Presentamos el caso de un varón de 70 años con déficit de F. XIII adquirido, no diagnosticado previamente, que tras ser intervenido por un carcinoma epidermoide de suelo de boca sufrió un sangrado de cavidad oral y cervical bilateral con compromiso de la vía aérea.

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Section: Discussionunclassified

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Déficit adquirido de Factor XIII como causa de hemorragia masiva con compromiso de vía aérea superior en cirugía oncológica de cavidad oral

Saez-Torres¹,

Fidalgo²,

Cobo³

et al. 2023

j.maxilo

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“…Due to this change FXIIIa (activated FXIII) is able to build covalent cross-links of fibrin monomers to anneal clot firmness [9,25,26]. Furthermore, by attaching alpha-2antiplasmin into the clot, FXIIIa also improves fibrinolysis-resistance and by engrafting fibronectin, collagen and other extracellular matrix proteins adhesion to the endothelium [8,9,[25][26][27][28]. By inhibition of FXIII with antibodies in an in vitro study, Jámbor et al verified a reduction of maximum clot firmness while clot formation time and clot lysis have been increased [29].…”

Section: Discussionmentioning

confidence: 99%

In vitro Influence of Fibrinogen and Factor XIII on Viscoelastic Characteristics of Clot Formation under Hypothermia and Acidosis

Da¹

2015

Int J Blood Res Disord

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platelets and coagulant proteins such as fibrinogen. Furthermore, fibrinogen is affected by dilutional coagulopathy. It is the first coagulation factor that decreases in trauma associated dilution coagulopathy [6,7]. Intensified blood loss during coagulopathy can occur when fibrinogen deficiency is combined with reduced levels of FXIII, a transglutaminase that improves clot firmness by crosslinking of fibrin monomers [8,9]. Previous studies showed an improvement of platelet function as well as overall clot firmness during hypothermia and acidosis by administration of fibrinogen [10,11] and suggested a higher survival rate in an animal model [12]. An effect of additional administration of FXIII under such circumstances has not been examined to date. Thus we tested fibrinogen and FXIII in a model of hypothermia and acidosis on viscoelastic effects on clot formation in vitro as assessed by rotation thromboelastometry. Materials and MethodsThe study was approved by the local ethic committee and was conducted according to the Helsinki Declarations and European Unions Convention on Human Rights and Biomedicine. 10 healthy volunteers were included into the study after oral and written informed consent. All volunteers were free of coagulation affecting medication or bleeding disorders.Blood samples were drawn from a cubital vein using an 18 gauge cannula. The first 5 ml were discarded. 21 ml were collected into 7 citrated tubes (Sarstedt AG & Co, Nümbrecht, Germany). Fibrinogen and FXIII levels were determined in the local standard laboratory (Fibrinogen: Dade ® Thrombin Reagent FXIII: Berichrom ® FXIII; both Siemens Healthcare Diagnostics, Marburg, Germany; both measured on a SYSMEX CS-2100i, SYSMEX GmbH, Norderstedt, Germany). Samples for rotation thromboelastometry were prepared according to a protocol which is displayed in table 1.

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“…Es ist noch zu klären, ob es in diesem Setting zu einem generellen Verlust von Gerinnungsfaktoren kommt oder ob einzelne, spezifisch erworbene Anomalien identifiziert werden können, wie z.B. Mangel an von-Willebrand-Faktor [100,101], Fibrinogen [102] und Faktor XIII [38,103,104]. …”

Section: Optionen Zur Behandlung Perioperativer Koagulopathischer Bluunclassified

Peri- und intraoperative Gerinnungsstörungen und ihre Therapieempfehlungen

Korte¹

2013

Visc Med

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Hintergrund: Aufgrund neuer diagnostischer Technologien und der zunehmenden Verfügbarkeit von Gerinnungsfaktorkonzentraten hat die perioperative Hämostase in den letzten Jahren zunehmende Aufmerksamkeit erhalten. Methode: Die Literatur wurde im Hinblick auf die Diagnostik, Pathophysiologie und Behandlungsmöglichkeiten von peri- und intraoperativen Gerinnungsstörungen sowie bezüglich eigener Erfahrungen in den verschiedenen erwähnten Bereichen durchsucht. Ergebnisse und Schlussfolgerungen: Peri- und intraoperative Hämostasestörungen sind nicht selten. Sie sind in der Regel mit einem strukturierten diagnostischen Vorgehen klinisch einfach zu erfassen. Mittlerweile können innerhalb der unterschiedlichen klinischen Entitäten verschiedene zugrunde liegende Pathophysiologien identifiziert werden; damit können auch die entsprechenden, zum Teil unterschiedlichen Behandlungsmethoden zum Einsatz gebracht werden. Die kontinuierliche Beobachtung der klinischen Situation zusammen mit unter Umständen wiederholten Laboruntersuchungen erlaubt die frühzeitige Erfassung und Behandlung.

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Postoperative Bleeding in a Patient With Normal Screening Coagulation Tests

Cited by 5 publications

References 12 publications

Déficit adquirido de Factor XIII como causa de hemorragia masiva con compromiso de vía aérea superior en cirugía oncológica de cavidad oral

Déficit adquirido de Factor XIII como causa de hemorragia masiva con compromiso de vía aérea superior en cirugía oncológica de cavidad oral

In vitro Influence of Fibrinogen and Factor XIII on Viscoelastic Characteristics of Clot Formation under Hypothermia and Acidosis

Peri- und intraoperative Gerinnungsstörungen und ihre Therapieempfehlungen

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