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Relevant bleeding diathesis due to acquired factor XIII deficiency.

M Janning1, K Holstein, B Spath

  • 1Priv.-Doz. Dr. med. Florian Langer, II. Medizinische Klinik und Poliklinik, Hubertus Wald Tumorzentrum - Universitäres Cancer Center Hamburg (UCCH), Universitätsklinikum Eppendorf, Martinistr. 52, 20246 Hamburg, Germany, Tel. +49/(0)40/741 05 24 53, Fax +49/(0)40/741 05 51 93,

Hamostaseologie
|October 31, 2013
PubMed
Summary

Acquired factor XIII (FXIII) deficiency can cause severe bleeding in non-surgical patients. This case highlights the importance of recognizing FXIII deficiency in patients with unexplained bleeding, even without surgery.

Keywords:
DICFaktor XIIIaortic aneurysmfibrinolysistranexamic acid

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Area of Science:

  • Hematology
  • Coagulation Disorders

Background:

  • Acquired factor XIII (FXIII) deficiency is known to impair clot firmness and increase bleeding risk in surgical patients.
  • Limited data exist on the hemostatic significance of acquired FXIII deficiency in non-surgical contexts.

Observation:

  • An 81-year-old patient with a history of aortic dissection presented with 3 years of progressive mucocutaneous and soft-tissue bleeding.
  • Coagulation tests were normal, but FXIII and alpha2-antiplasmin levels were low (33% and 27%), with elevated D-dimer (>35 mg/l).
  • Imaging revealed a significantly dilated aorta with an extensive false lumen; FXIII inhibitor was ruled out.

Findings:

  • Severe bleeding tendency in non-surgical patients can be associated with acquired FXIII deficiency at activity levels of 30-35%.
  • This risk is amplified in the presence of increased thrombin and fibrin generation.

Implications:

  • Highlights the potential for significant bleeding complications from acquired FXIII deficiency in non-surgical settings.
  • Suggests the need for careful coagulation assessment, including FXIII levels, in non-surgical patients with unexplained bleeding.
  • Effective management can be achieved with FXIII concentrate and tranexamic acid.