[A 79-year-old patient with severe bleeding after colon surgery and normal global coagulation parameters]

We report the case of a 79-year-old Caucasian male, who underwent anterior resection of the rectum for treatment of a colorectal carcinoma. Two days after the surgery, the patient had mild but persistent haemorrhage from all drains and around the wounds which eventually required blood transfusion (18 units of erythrocyte concentrate and 8 units of fresh-frozen plasma). Endoscopy revealed no surgical bleeding source, and standard coagulation tests were inconspicuous. Based on suspicion of factor XIII deficiency, the patient was treated with factor XIII concentrate (1250 I.U. injections twice daily), starting on day 4 of bleeding. The bleeding stopped after the second dose of factor XIII. Laboratory testing retrospectively revealed the lack of factor XIII (43 % at the first day of dosing). Factor XIII concentrate was administered for 10 days. Withdrawal of factor XIII after 9 days of treatment led to a bleeding recurrence. After resuming treatment for one more day, the therapy could be stopped without further bleeding. Thus, factor XIII deficiency should be considered in patients with unexplained postoperative bleeding and appropriate diagnostic measures be taken early. In cases of medical emergency, probative administration of factor XIII may be justified.