Published online Jan 7, 2022. doi: 10.12998/wjcc.v10.i1.242
Peer-review started: December 27, 2020
First decision: July 8, 2021
Revised: July 12, 2021
Accepted: November 25, 2021
Article in press: November 25, 2021
Published online: January 7, 2022
Factor XI (FXI) deficiency, also known as hemophilia C, is a rare bleeding disorder of unpredictable severity that correlates poorly with FXI coagulation activity. This often poses great challenges in perioperative hemostatic management. Thromboelastography (TEG) is a method for testing blood coagulation using a viscoelastic hemostatic assay of whole blood to assess the overall coagulation status. Here, we present the successful application of intraoperative TEG monitoring in an FXI-deficient patient as an individualized blood transfusion strategy.
A 21-year-old male patient with FXI deficiency was scheduled to undergo reconstructive surgery for macrodactyly of the left foot under general anesthesia. To minimize his bleeding risk, he was scheduled to receive fresh frozen plasma (FFP) as an empirical prophylactic FXI replacement at a dose of 15-20 mL/kg body weight (900-1200 mL) before surgery. Subsequent FFP transfusion was to be adjusted according to surgical need. Instead, TEG assessment was used at the beginning and toward the end of his surgery. According to intraoperative TEG results, the normalization of coagulation function was achieved with an infusion of only 800 mL FFP, and blood loss was minimal. The patient showed an uneventful postoperative course and was discharged on postoperative day 8.
TEG can be readily applied in the intraoperative period to individualize transfusion needs in patients with rare inherited coagulopathy.
Core Tip: Factor XI (FXI) deficiency is a rare bleeding disorder of unpredictable severity that correlates poorly with FXI coagulation activity and that poses great challenges for perioperative hemostatic management. Thromboelastography (TEG) is a method for testing blood coagulation using a viscoelastic hemostatic assay of whole blood to assess overall coagulation status; it is readily available and provides real-time monitoring. This case report highlights the importance of using TEG in the intraoperative period to individualize transfusion needs for patients with rare inherited coagulopathy and to minimize transfusion-related risks.