Guo WJ, Chen WY, Yu XR, Shen L, Huang YG. Intraoperative thromboelastography-guided transfusion in a patient with factor XI deficiency: A case report. World J Clin Cases 2022; 10(1): 242-248 [PMID: 35071523 DOI: 10.12998/wjcc.v10.i1.242]
Corresponding Author of This Article
Le Shen, MD, PhD, Professor, Department of Anesthesiology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan, Beijing 100730, China. pumchshenle@163.com
Research Domain of This Article
Anesthesiology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Jan 7, 2022; 10(1): 242-248 Published online Jan 7, 2022. doi: 10.12998/wjcc.v10.i1.242
Intraoperative thromboelastography-guided transfusion in a patient with factor XI deficiency: A case report
Wen-Juan Guo, Wei-Yun Chen, Xue-Rong Yu, Le Shen, Yu-Guang Huang
Wen-Juan Guo, Wei-Yun Chen, Xue-Rong Yu, Yu-Guang Huang, Department of Anesthesiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China
Le Shen, Department of Anesthesiology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China
Author contributions: Guo WJ contributed to the clinical conduct of the case, to data collection, and to the writing of the manuscript; Chen WY and Yu XR contributed to the intraoperative TEG assessment; Shen L and Huang YG contributed to the analysis and interpretation of the collected data and to the revision of the manuscript.
Supported byEducation Reform Project Foundation for the Central Universities of Peking Union Medical College, No. 2020zlgc0105; Training Programme Foundation for Excellent Talent in Dongcheng District of Beijing, No. 2019DCT-M-08; and Non-profit Central Research Institute Fund of Chinese Academy of Medical Sciences, No. 2019XK320018.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Le Shen, MD, PhD, Professor, Department of Anesthesiology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan, Beijing 100730, China. pumchshenle@163.com
Received: December 27, 2020 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 Processing time: 367 Days and 9 Hours
Abstract
BACKGROUND
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.
CASE SUMMARY
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.
CONCLUSION
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.
