Optimizing the anesthetic management of factor XI deficiency in obstetrics: A case report using ROTEM

Area of Science:

• Obstetrics and Gynecology
• Anesthesiology
• Hematology

Background:

• Factor XI (FXI) deficiency presents challenges in obstetric anesthesia due to unpredictable bleeding risk.
• Neuraxial anesthesia is often avoided due to concerns of spinal hematoma in FXI deficiency.
• Viscoelastic testing, like rotational thromboelastometry (ROTEM), may offer functional coagulation insights.

Observation:

• A 28-year-old primigravid woman with incidental moderate FXI deficiency (52.6%) and minimal bleeding history underwent preoperative evaluation.
• Rotational thromboelastometry (ROTEM) revealed a mildly prolonged clotting time and slightly reduced early clot firmness, but preserved maximum clot firmness.
• Spinal anesthesia was administered for elective Cesarean section under prophylactic tranexamic acid due to the integrative evaluation.

Findings:

• The Cesarean section was performed uneventfully with an estimated blood loss of 450 mL and no hemostatic complications.
• Rotational thromboelastometry (ROTEM) supported multidisciplinary decision-making for anesthesia in this Factor XI deficient patient.
• Postoperative ROTEM showed improvement, likely due to postpartum procoagulant changes and tranexamic acid, not solely ROTEM-guided intervention.

Implications:

• Rotational thromboelastometry (ROTEM) can be a valuable adjunct in the individualized management of Factor XI deficiency during pregnancy and obstetric anesthesia.
• ROTEM's role is complementary, aiding decision-making alongside clinical assessment.
• Further prospective studies are needed to establish standardized thresholds and clarify ROTEM's predictive value in FXI deficiency.