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Perioperative course of FXIII in children undergoing major surgery
Thorsten Haas1, Wolfgang Korte, Nelly Spielmann
1Department of Anaesthesia, University Children's Hospital Zurich, Steinwiesstrasse 75, Zurich, Switzerland. thorsten.haas@kispi.uzh.ch
Insights
Pediatric major surgery causes early decreases in coagulation factor XIII due to hemodilution. Even with fresh frozen plasma transfusions, factor XIII levels remain low throughout the procedure.
Area of Science:
- Pediatric Anesthesiology
- Hemostasis and Thrombosis
- Surgical Coagulation
Background:
- Acquired deficiency of coagulation factor XIII (FXIII) from perioperative hemodilution is documented in adults.
- Limited data exists on FXIII levels in pediatric patients undergoing major surgery.
Purpose of the Study:
- To prospectively evaluate the intraoperative course of FXIII in children undergoing elective major surgery.
- To assess FXIII concentrations, fibrinogen levels, and thrombelastometry during pediatric surgery.
Main Methods:
- Prospective observational trial involving 46 children (0.3-16 years) undergoing major surgery.
- Repeated blood sampling for FXIII, fibrinogen, and cell counts.
- Intraoperative thrombelastometry using ROTEM®.
Main Results:
- Significant FXIII decrease (median 60%) noted at surgery start, further dropping to 33% intraoperatively.
- Fibrinogen levels decreased to 130 mg·dl⁻¹, while ROTEM® traces largely remained unchanged.
- Despite fresh frozen plasma transfusions in 21/46 children, FXIII remained low (39%) until surgery end.
Conclusions:
- Coagulation factor XIII levels decrease early during pediatric major surgery due to hemodilution.
- Intraoperative FXIII levels remain low despite fresh frozen plasma transfusions.
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.
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