Management of factor XI deficiency in oncological liver and colorectal surgery by therapeutic plasma exchange: A case report.

Autor: Burgos Pratx LD; Transfusion Medicine Deparment, Hospital Italiano de Buenos Aires, Argentina. Electronic address: leandro.burgos@hospitalitaliano.org.ar., Santoro DM; Transfusion Medicine Deparment, Hospital Italiano de Buenos Aires, Argentina., Mileo FG; Department of Anesthesiology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina., Martinuzzo ME; Laboratorio Central del Hospital Italiano de Buenos Aires, Departamento de Bioquímica Aplicada, Instituto Universitario del Hospital Italiano, Buenos Aires, Argentina., Ardiles V; Department of Surgery, Division of HPB Surgery, Liver Transplant Unit, Hospital Italiano de Buenos Aires, Argentina., de Santibañes E; Department of Surgery, Division of HPB Surgery, Liver Transplant Unit, Hospital Italiano de Buenos Aires, Argentina., Salamone HJ; Transfusion Medicine Deparment, Hospital Italiano de Buenos Aires, Argentina.
Jazyk: angličtina
Zdroj: Transfusion and apheresis science : official journal of the World Apheresis Association : official journal of the European Society for Haemapheresis [Transfus Apher Sci] 2021 Oct; Vol. 60 (5), pp. 103176. Date of Electronic Publication: 2021 May 31.
DOI: 10.1016/j.transci.2021.103176
Abstrakt: Introduction: Factor XI (FXI) deficiency is a rare congenital hemostatic disorder associated with increased bleeding tendency in trauma, surgery or when other hemostatic defects are present. Perioperative hemostatic management of a patient with a severe FXI deficiency undergoing major oncological liver and colorectal surgery with therapeutic plasma exchange (TPE) with fresh frozen plasma (FFP) is reported.
Case Description: A 54-year-old male with severe FXI deficiency was scheduled for resection of synchronous rectal cancer and multiple liver metastases. Baseline prothrombin time (PT) was 97 %, activated partial thromboplastin time (aPTT) 89 s(s) and FXI levels <1 IU/dL. The rotational thromboelastometry (ROTEM™) presented a prolonged INTEM clotting time (CT) = 443 s (RV 100-240 s) and a clot formation time (CFT) = 110 s (RV 30-100 s). TPE with FFP was carried out achieving FXI levels up to 46 IU/dL and an aPTT of 33 s, normalizing thromboelastometry parameters to an INTEM CT = 152 s and a CFT = 86 s before the procedure. After surgery, the patient received daily FFP to maintain FXI levels above 30 IU/dL until discharge on the eighth day. A total of 30 FFP units were transfused during hospital stay. No significant bleeding events neither transfusion related complications were observed during the perioperative period.
Conclusion: Given the lack of correlation between FXI levels and bleeding risk, a multidisciplinary approach based on daily FXI levels monitoring, close clinical assessment and factor supplementation is mandatory. In conclusion, TPE with FFP is an efficacious alternative strategy to correct severe FXI deficiency in patients undergoing major surgery.
(Copyright © 2021 Elsevier Ltd. All rights reserved.)
Databáze: MEDLINE
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