Cardiopulmonary Bypass in a Patient with Factor XII Deficiency

Area of Science:

• Cardiovascular Surgery
• Hematology
• Coagulation Disorders

Background:

• Cardiopulmonary bypass (CPB) management in factor XII-deficient patients presents challenges due to ineffective anticoagulation monitoring via activated clotting time (ACT).
• Factor XII deficiency impairs the contact activation system, crucial for normal ACT measurement.
• Factor XII also plays a role in fibrinolysis, and its deficiency is linked to increased thrombosis risk.

Observation:

• A case report details the surgical revascularization of a factor XII-deficient patient using CPB.
• The patient's factor XII level was restored with fresh-frozen plasma immediately before the procedure.

Findings:

• This pre-operative factor XII replenishment normalized baseline ACT, allowing for reliable ACT monitoring during CPB.
• The intervention facilitated successful CPB performance in a patient with a known coagulation defect.

Implications:

• Perioperative management strategies are essential to mitigate the risk of postoperative thromboembolic events due to the rapid return of factor XII to baseline levels.
• This case highlights a potential therapeutic approach for managing factor XII deficiency during cardiac surgery.
• Further research may explore optimal factor XII replacement protocols and long-term thrombotic risk management in these patients.