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Livanou ME, Matsas A, Valsami S, Papadimitriou DT, Kontogiannis A, Christopoulos P. Clotting Factor Deficiencies as an Underlying Cause of Abnormal Uterine Bleeding in Women of Reproductive Age: A Literature Review. Life (Basel) 2023; 13:1321. [PMID: 37374104 DOI: 10.3390/life13061321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 05/27/2023] [Accepted: 06/02/2023] [Indexed: 06/29/2023] Open
Abstract
Clotting Factor deficiencies are rare disorders with variations in clinical presentation and severity of symptoms ranging from asymptomatic to mild to life-threatening bleeding. Thus, they pose a diagnostic and therapeutic challenge, mainly for the primary health care providers, general practitioners, and gynecologists who are more likely to first encounter these patients. An additional diagnostic challenge arises from the variable laboratory presentations, as PT, PTT, and BT are not always affected. The morbidity is higher among women of reproductive age since Abnormal Uterine Bleeding-specifically Heavy Menstrual Bleeding-is one of the most prevalent manifestations of these disorders, and in some cases of severe deficiencies has led to life-threatening episodes of bleeding requiring blood transfusions or even immediate surgical intervention. Physician awareness is important as, in the case of some of these disorders-i.e., Factor XIII deficiency-prophylactic treatment is available and recommended. Although uncommon, the potential for rare bleeding disorders and for hemophilia carrier states should be considered in women with HMB, after more prevalent causes have been excluded. Currently, there is no consensus on the management of women in these instances and it is reliant on the physicians' knowledge.
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Affiliation(s)
- Maria Effrosyni Livanou
- Second Department of Obstetrics and Gynecology, "Aretaieion" Hospital, Faculty of Medicine, National and Kapodistrian University of Athens, 115 28 Athens, Greece
| | - Alkis Matsas
- Second Department of Obstetrics and Gynecology, "Aretaieion" Hospital, Faculty of Medicine, National and Kapodistrian University of Athens, 115 28 Athens, Greece
| | - Serena Valsami
- Hematology Laboratory-Blood Bank, Aretaieion Hospital, National and Kapodistrian University of Athens, 115 28 Athens, Greece
| | - Dimitrios T Papadimitriou
- Second Department of Obstetrics and Gynecology, "Aretaieion" Hospital, Faculty of Medicine, National and Kapodistrian University of Athens, 115 28 Athens, Greece
| | - Athanasios Kontogiannis
- Second Department of Obstetrics and Gynecology, "Aretaieion" Hospital, Faculty of Medicine, National and Kapodistrian University of Athens, 115 28 Athens, Greece
| | - Panagiotis Christopoulos
- Second Department of Obstetrics and Gynecology, "Aretaieion" Hospital, Faculty of Medicine, National and Kapodistrian University of Athens, 115 28 Athens, Greece
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Sperry JD, Rose AE, Williams E, Dierks MR, Medow JE. Emergent Reversal of Antithrombotics and Treatment of Life-Threatening Bleeding from Coagulopathies: A Clinical Review. J Emerg Med 2022; 63:17-48. [PMID: 35918220 DOI: 10.1016/j.jemermed.2022.05.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 04/29/2022] [Accepted: 05/09/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Reversal of antithrombotic agents and treatment of life-threatening bleeding episodes from coagulopathies can be a stressful scenario for clinicians, especially when the selection of treatment options should occur quickly. Understanding the options available for these agents requires emergency physicians to be familiar with the current data surrounding new therapies and dosing strategies for the treatment of bleeding from reversible and nonreversible antithrombotics and coagulopathic conditions. OBJECTIVE To provide quick resource guides for the reversal of major or life-threatening bleeding caused by antithrombotic agents or in the setting of coagulopathies. METHODS A literature search for articles published through September 2021 related to antithrombotic reversal and treatment of acute bleeding from coagulopathies was conducted using the PubMed clinical database. Selected articles were used to generate 5 guidance tables in this clinical review. DISCUSSION Four guidance tables for how to treat major or life-threatening bleeding from antithrombotic agents and 1 table for how to manage life-threatening bleeding for coagulopathies are presented as a quick reference tool for the emergency physician. Additional information on upcoming reversal agents and possible treatment options are provided herein. CONCLUSIONS In this clinical review, a series of 5 tables were created to provide quick and comprehensive guidance for the emergency physician when treating major or life-threatening bleeding caused by antithrombotic agents or coagulopathies. © 2022 Elsevier Inc.
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Affiliation(s)
- Jeffrey D Sperry
- Department of Pharmacy, University of Wisconsin Hospitals and Clinics, Madison, Wisconsin
| | - Anne E Rose
- Department of Pharmacy, University of Wisconsin Hospitals and Clinics, Madison, Wisconsin
| | - Eliot Williams
- Department of Hematology, University of Wisconsin Hospitals and Clinics, Madison, Wisconsin
| | - Matthew R Dierks
- Department of Pharmacy, University of Wisconsin Hospitals and Clinics, Madison, Wisconsin
| | - Joshua Eric Medow
- Department of Neurosurgery, University of Wisconsin Hospitals and Clinics, Madison, Wisconsin
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3
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Wattakavanich N, Boonrod A, Wanitpongpun C, Tharakulphan S. Abnormally Prolonged Bleeding After an Arthroscopic Knee Reconstruction Because of an Inherited Factor XIII Deficiency: A Case Report. JBJS Case Connect 2021; 11:01709767-202112000-00068. [PMID: 35102034 DOI: 10.2106/jbjs.cc.21.00419] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
CASE An 18-year-old man developed ecchymosis after arthroscopic anterior cruciate ligament reconstruction with semitendinosus graft and meniscal repair. The results of routine coagulation studies were normal, but factor assays showed a reduction in factor XIII levels. The bleeding symptoms were dramatically improved after administration of cryoprecipitate. CONCLUSION Factor XIII deficiency is one of the rare clotting factor deficiencies that can be present at birth or be manifested later in life. Clinical awareness of factor XIII deficiency is essential so that appropriate testing and treatment can be achieved.
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Affiliation(s)
- Narusorn Wattakavanich
- Department of Orthopaedics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Artit Boonrod
- Department of Orthopaedics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Chinadol Wanitpongpun
- Hematology Unit, Department of Internal Medicine, Srinagarind Hospital, Khon Kaen University, Khon Kaen, Thailand
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Singh S. Factor XIII deficiency: Lessons from two patients with unusual bleeding. THE NATIONAL MEDICAL JOURNAL OF INDIA 2021; 34:276-278. [PMID: 35593251 DOI: 10.25259/nmji_140_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- Suvir Singh
- Department of Clinical Haematology and Bone Marrow Transplantation, Dayanand Medical College, Ludhiana, Punjab, India
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Furtado SV, Hegde P, Palassery R, Karunakara BP. Factor XIII Deficiency and Intracranial Bleed: Surgical Management and Prophylaxis with Cryoprecipitate. JOURNAL OF PEDIATRIC NEUROLOGY 2021. [DOI: 10.1055/s-0041-1731026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
AbstractFactor XIII (FXIII) deficiency is a rare bleeding disorder with affected patients having high propensity for intracranial hemorrhage. A 12-year-old girl presented with severe headache, limb weakness, and rapidly worsening sensorium over 4 days. Magnetic resonance imaging of the brain and computed tomography (CT) of the head showed intraparenchymal bleed. Patient had normal coagulation profile and abnormal FXIII level. The perioperative management included cryoprecipitate transfusion to bring the FXIII value to 74%. She underwent craniotomy and evacuation of the hematoma. Postoperatively, she received prophylaxis against rebleed with cryoprecipitate. In the absence of FXIII concentrate, correction of FXIII deficiency is possible with cryoprecipitate in emergent situations.
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Affiliation(s)
- Sunil V. Furtado
- Department of Neurosurgery, Ramaiah Medical College Hospital, Bangalore, India
| | - Pranoy Hegde
- Department of Neurosurgery, Ramaiah Medical College Hospital, Bangalore, India
| | - Rasmi Palassery
- Department of Medical Oncology, Ramaiah Medical College Hospital, Bangalore, India
| | - B. P. Karunakara
- Department of Pediatrics, Ramaiah Medical College Hospital, Bangalore, India
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Farzam K. A Rare Case of Factor XIII Deficiency in the Setting of Cancer Immunotherapy. Cureus 2021; 13:e15299. [PMID: 34084689 PMCID: PMC8163106 DOI: 10.7759/cureus.15299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Factor XIII deficiency is a rare bleeding disorder, which may be congenital or acquired, and is most commonly diagnosed in early childhood. It has a prevalence that is as low as one in 5,000,000. Acquired factor XIII deficiency is considered to be a more rare form, with less than 100 cases reported in the literature. This disorder can be clinically characterized by recurrent and severe unexplained bleeding. This case describes a patient with no prior bleeding disorders, who suffered from recurrent bleeding episodes while being treated with cancer immunotherapy, specifically pembrolizumab, and was subsequently diagnosed with factor XIII deficiency. She required cryoprecipitate infusion due to the persistent bleeding and subsequently developed saddle pulmonary embolism. The patient was not a candidate for tissue plasminogen activator (tPA) due to her recurrent bleeding and required mechanical thrombectomy. Given the timeline of symptoms, the patient likely developed acquired factor XIII deficiency due to her cancer immunotherapy.
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Affiliation(s)
- Khashayar Farzam
- Family Medicine, University of Iowa Hospitals and Clinics, Iowa City, USA
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7
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Rugeri L, Martinaud C, Beurrier P, Borg Y, Chambost H, Chirila-Hetsch M, Desprez D, Harroche A, Milien V, Pan-Petesch B, Meunier S. Gynecological and obstetric outcome in the French cohort of women with factor XIII deficiency. Thromb Res 2020; 191:22-25. [PMID: 32360976 DOI: 10.1016/j.thromres.2020.04.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 03/17/2020] [Accepted: 04/08/2020] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Congenital factor XIII deficiency is a very rare bleeding disorder affecting 33 patients in France. Besides its role in fibrin clot stabilization, factor XIII is involved in placental attachment. Fetal miscarriages represent a frequent and concerning issue for these patients. The aim of the present study was to describe clinical characteristics of women presenting severe congenital FXIII deficiency in France, to focus on gynecological and obstetrical events, and to report the management of these rare situations. METHODS We conducted a retrospective study in the French Hemophilia Comprehensive Care and Clinical Hemostasis Centers. Women between 15 and 65 years with factor XIII activity <10 IU dL-1 were included. Biological, clinical and therapeutic events that occurred to these patients during their gynecological and obstetrical period were recorded. RESULTS Among 31 centers, eleven patients were included. The median age at diagnosis was 1.5 years (range: 0-35), and at inclusion it was 30 years (range: 15-63). Fetal miscarriage was the primary manifestations in 2 (18%) patients, the remaining were diagnosed during hemorrhage. Menorrhagias were reported by 2 women (27%), 13 pregnancies were reported by 9 women including one abortion. Every pregnancy was conducted under factor XIII substitution, no hemorrhagic episode was reported. Four patients (36%) experienced at least one fetal miscarriage with a total amount of 30 miscarriages with 6 occurring during substitution. CONCLUSION Altogether, our data confirmed the high incidence of miscarriage in women with factor XIII deficiency. Good outcome of pregnancies required prophylaxis in accordance with international guidelines.
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Affiliation(s)
- Lucia Rugeri
- Hospices Civils de Lyon, Unité Hémostase Clinique, Hôpital Louis Pradel, Hospices Civils de Lyon, Bron, France.
| | | | | | - Yvonne Borg
- Unité Hémostase et Centre Régional de Traitement des maladies Hémorragiques, Institut de Biologie Clinique, Hôpital Charles Nicolle, Rouen, France
| | - Hervé Chambost
- Centre for Bleeding Disorders, Pediatric Haematology Oncology Department, University Hospital La Timone, AP-HM, and Aix Marseille Univ, INSERM, INRA, C2VN, Marseille, France
| | | | - Dominique Desprez
- Centre de Traitement de l'Hémophilie, CHU Strasbourg, Strasbourg, France
| | - Annie Harroche
- Hemophilia Care Centre, Hematology Unit, Hôpital Universitaire Necker Enfants Malades, Paris, France
| | - Vanessa Milien
- FranceCoag, University Hospital La Timone, AP-HM, Marseille, France
| | | | - Sandrine Meunier
- Hospices Civils de Lyon, Unité Hémostase Clinique, Hôpital Louis Pradel, Hospices Civils de Lyon, Bron, France
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Bouttefroy S, Meunier S, Milien V, Boucekine M, Chamouni P, Desprez D, Harroche A, Hochart A, Thiercelin-Legrand MF, Wibaut B, Chambost H, Rugeri L. Congenital factor XIII deficiency: comprehensive overview of the FranceCoag cohort. Br J Haematol 2019; 188:317-320. [PMID: 31414482 DOI: 10.1111/bjh.16133] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Accepted: 06/13/2019] [Indexed: 11/28/2022]
Abstract
This FranceCoag network study assessed 33 patients with congenital factor XIII (FXIII) deficiency presenting FXIII levels <10 iu/dl. Diagnosis was based on abnormal bleeding in 29 patients, a positive family history in 2, recurrent miscarriages in 1 and was fortuitous in 1. Eighteen patients (62·1%) presented life-threatening umbilical or intracranial haemorrhages (ICH). Seven of the 15 patients who experienced ICH were diagnosed but untreated, including 3 with secondary neurological sequelae. All pregnancies without prophylaxis (26/26) led to miscarriages versus 3/16 with prophylaxis. In patients exhibiting FXIII levels <10 iu/dl, prophylaxis could be discussed at diagnosis and at pregnancy. Further controlled prospective studies are needed.
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Affiliation(s)
- Séverine Bouttefroy
- Hospices Civils de Lyon - Unite d'Hemostase Clinique, Hôpital Cardiologique Louis Pradel, Lyon, France
| | - Sandrine Meunier
- Hospices Civils de Lyon - Unite d'Hemostase Clinique, Hôpital Cardiologique Louis Pradel, Lyon, France
| | | | | | - Pierre Chamouni
- Hemophilia Care Center, Rouen University Hospital, Rouen, France
| | - Dominique Desprez
- Haemophilia Treatment Centre, Strasbourg University Regional Hospital, Strasbourg, France
| | - Annie Harroche
- Haemophilia Treatment Centre, APHP, Hospital Necker, Paris, France
| | - Audrey Hochart
- Haematology and Transfusion, CHU Lille, Hospital Necker, Lille, France
| | | | - Bénédicte Wibaut
- Haematology and Transfusion, CHU Lille, Hospital Necker, Lille, France
| | - Hervé Chambost
- AP-HM, FranceCoag, Marseille, France.,Hemophilia Care Center, La Timone Hospital and Aix Marseille Univ, INSERM, INRA, C2VN, Marseille, France
| | - Lucia Rugeri
- Hospices Civils de Lyon - Unite d'Hemostase Clinique, Hôpital Cardiologique Louis Pradel, Lyon, France
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Shapiro A. The use of prophylaxis in the treatment of rare bleeding disorders. Thromb Res 2019; 196:590-602. [PMID: 31420204 DOI: 10.1016/j.thromres.2019.07.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 07/02/2019] [Accepted: 07/16/2019] [Indexed: 12/15/2022]
Abstract
Rare bleeding disorders (RBDs) are a heterogeneous group of coagulation factor deficiencies that include fibrinogen, prothrombin, α2-antiplasmin, plasminogen activator inhibitor-1, and factors II, V, V/VIII, VII, X, XI and XIII. The incidence varies based upon the disorder and typically ranges from 1 in 500,000 to 1 per million population. Symptoms vary with the disorder and residual level of the clotting factor, and can range from relatively minor such as epistaxis, to life threatening, such as intracranial hemorrhage. Rapid treatment of bleeding episodes in individuals with severe bleeding phenotypes is essential to preserve life or limb and to prevent long-term sequelae; therapeutic options depend on the deficiency and range from plasma-derived (eg, fresh frozen plasma, prothrombin complex concentrates, factor X concentrate) to highly purified and recombinant single factor concentrates. The rarity of these disorders limits the feasibility of conventional prospective clinical trials; instead, clinicians rely upon registries, published case reports/series and experience to guide treatment. In some disorders, long-term prophylactic therapy is administered in response to the bleeding phenotype in an individual patient or based on the known natural history and severity of the deficiency. Intermittent prophylaxis, surrounding surgery, pregnancy, labor, and menstruation may be required to prevent or control excessive bleeding. This review summarizes therapeutic options, guidelines, recommendations and observations from the published literature for long-term, surgical, gynecological, and obstetric prophylaxis in deficiencies of fibrinogen; prothrombin; factors II, V, V/VIII, VII, X, XI and XIII; combined vitamin-K dependent factors; α2-antiplasmin; and plasminogen activator inhibitor 1. Platelet disorders including Glanzmann's thrombasthenia and Bernard-Soulier syndrome are also addressed.
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Affiliation(s)
- Amy Shapiro
- Indiana Hemophilia & Thrombosis Center, 8326 Naab Rd., Indianapolis, IN 46260, USA.
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MARAŞLI H, ACIPAYAM C, BOZKAYA A, TUNCEL DA, ÇAKMAKLI S, ÇOBANUŞAĞI M, YURTTUTAN S. Masif Umbilikal Kanama ile Başvuran Daha Önce Tanımlanmamış Faktör XIII Subünit A Mutasyonlu Bir Olgu (Factor XIII A1 gen; NM_000129.3 c.1817_1817delA (p.H606Pfs*23) (p.His606Profs*23, homozygous). KAHRAMANMARAŞ SÜTÇÜ İMAM ÜNIVERSITESI TIP FAKÜLTESI DERGISI 2019. [DOI: 10.17517/ksutfd.467713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Aydin Ozturk P, Sanri O, Yilmaz A, Arpa A, Ozturk U, Ceviz A. Choroid Plexus Papilloma and Factor XIII Deficiency: Case Report. Pediatr Neurosurg 2018; 53:413-415. [PMID: 30176663 DOI: 10.1159/000492334] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 07/22/2018] [Indexed: 11/19/2022]
Abstract
Factor XIII deficiency is a rare hemorrhagic disorder that can cause spontaneous intracranial hemorrhage and bleeding after surgery. The diagnosis of factor XIII deficiency is difficult before surgical interventions, because coagulation parameters are normal in these patients. Important clinical findings are postsurgical bleeding and recurrent spontaneous intracranial hematomas. These findings should raise the clinical suspicion of factor XIII deficiency. Therefore, diagnosis of factor XIII deficiency is very important for neurologists and neurosurgeons in terms of reducing mortality and morbidity. We present an 8-month-old female patient who developed subdural hematoma after ventriculoperitoneal shunt surgery but not bleeding after choroid plexus papilloma due to FXIII deficiency.
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Affiliation(s)
- Pinar Aydin Ozturk
- Department of Neurosurgery, Health Science University Gazi Yasargil Education Research Hospital, Diyarbakir,
| | - Omer Sanri
- Department of Neurosurgery, Dicle University Medical Faculty, Diyarbakir, Turkey
| | - Adil Yilmaz
- Department of Neurosurgery, Dicle University Medical Faculty, Diyarbakir, Turkey
| | - Abdurrahman Arpa
- Department of Neurosurgery, Dicle University Medical Faculty, Diyarbakir, Turkey
| | - Unal Ozturk
- Department of Neurology, Health Science University Gazi Yasargil Education Research Hospital, Diyarbakir, Turkey
| | - Adnan Ceviz
- Department of Neurosurgery, Dicle University Medical Faculty, Diyarbakir, Turkey
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Pitkänen HH, Jouppila A, Lemponen M, Ilmakunnas M, Ahonen J, Lassila R. Factor XIII deficiency enhances thrombin generation due to impaired fibrin polymerization - An effect corrected by Factor XIII replacement. Thromb Res 2016; 149:56-61. [PMID: 27902939 DOI: 10.1016/j.thromres.2016.11.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 10/31/2016] [Accepted: 11/12/2016] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Factor XIII (FXIII) cross-links fibrin, completing blood coagulation. Congenital FXIII deficiency is managed with plasma-derived FXIII (pdFXIII) or recombinant FXIII (rFXIII) concentrates. AIM As the mechanisms protecting patients with low FXIII levels (<5IU/dL) from spontaneous bleeds remain unknown we assessed the interplay between thrombin generation (TG), fibrin formation and clot kinetics before and after FXIII administration in three patients with FXIII deficiency. METHODS Patients received initially rFXIII (35IU/kg, A-subunit) following with pdFXIII at 1250IU or 2500IU (12-30IU/kg) monthly. TG (CAT), thromboelastometry (ROTEM), prothrombin fragments F1+2, fibrinogen and FXIII activity (FXIII:C) were measured at baseline and one-hour recovery. RESULTS FXIII was at the target level of 20±6IU/dL at the 4-week trough. rFXIII corrected FXIII to 98±15 and high-dose pdFXIII to a level of 90±6, whereas low-dose/half dose pdFXIII reached 45±4IU/dL. Although fibrinogen (Clauss Method) was normal, coagulation in FIBTEM was impaired, which FXIII administration tended to correct. CAT implied 1.6- to 1.9-fold enhanced TG, which FXIII administration normalized. Inhibition of fibrin polymerization by Gly-Pro-Arg-Pro peptide mimicked FXIII deficiency in CAT by enhancing TG both in control and FXIII recovery plasma. Antithrombin, α2-macroblobulin-thrombin complex and prothrombin were normal, whereas F1+2 were elevated compatible with in vivo TG. DISCUSSION FXIII deficiency impairs fibrinogen function and fibrin formation simultaneously enhancing TG on the poorly polymerizing fibrin strands, when fibrin's antithrombin I -like function is absent. Our study suggests an inverse link between low FXIII levels and enhanced TG modifying structure-function relationship of fibrin to support hemostasis.
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Affiliation(s)
- Hanna H Pitkänen
- Helsinki University Hospital Research Institute, Helsinki, Finland; Helsinki University, Division of Anaesthesiology, Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Annukka Jouppila
- Helsinki University Hospital Research Institute, Helsinki, Finland
| | - Marja Lemponen
- Coagulation Disorders Unit, Department of Haematology, Comprehensive Cancer Center, and HUSLAB and Laboratory Services HUSLAB, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Minna Ilmakunnas
- Helsinki University, Division of Anaesthesiology, Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Jouni Ahonen
- Helsinki University, Division of Anaesthesiology, Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Maternity Hospital, Helsinki University Hospital, Helsinki, Finland
| | - Riitta Lassila
- Coagulation Disorders Unit, Department of Haematology, Comprehensive Cancer Center, and HUSLAB and Laboratory Services HUSLAB, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
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Medical and Surgical Management of Postpartum Hemorrhage in a Woman with Factor XIII Deficiency. Case Rep Obstet Gynecol 2016; 2016:7963874. [PMID: 27635271 PMCID: PMC5007299 DOI: 10.1155/2016/7963874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 07/27/2016] [Accepted: 07/28/2016] [Indexed: 11/18/2022] Open
Abstract
Factor XIII deficiency is a rare inherited coagulopathy. Factor XIII is the last clotting factor in the coagulation cascade to insure strength and stability to fibrin clots. Without this enzyme, the fibrous clot is unstable and nonresistant to fibrinolysis. Gravid women with this congenital disease are especially at risk for complications including miscarriages and hemorrhage without appropriate interventions. We present a case of a woman in her 20s with Factor XIII deficiency who was treated with cryoprecipitate and had a successful normal spontaneous vaginal delivery; subsequently, patient suffered from postpartum hemorrhage and consumptive coagulopathy due to consumption of Factor XIII, requiring emergency surgical intervention. Intraoperative management was challenged by an ethical dilemma involving the patient's religious beliefs about not receiving blood. This paper will discuss the mechanism of Factor XIII and the medical and surgical management involved with this patient.
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Solomon C, Korte W, Fries D, Pendrak I, Joch C, Gröner A, Birschmann I. Safety of Factor XIII Concentrate: Analysis of More than 20 Years of Pharmacovigilance Data. Transfus Med Hemother 2016; 43:365-373. [PMID: 27781024 DOI: 10.1159/000446813] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Accepted: 01/11/2016] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Plasma-derived factor XIII (FXIII) concentrate is an effective treatment for FXIII deficiency. We describe adverse drug reactions (ADRs) reported during pharmacovigilance monitoring of Fibrogammin®/Corifact® and review published safety data. METHODS Postmarketing safety reports recorded by CSL Behring from June 1993 to September 2013 were analyzed. Clinical studies published during the same period were also reviewed. RESULTS Commercial data indicated that 1,653,450,333 IU FXIII concentrate were distributed over the review period, equivalent to 1,181,036 doses for a 70 kg patient. 75 cases were reported (one/15,700 standard doses or 22,046,000 IU). Reports of special interest included 12 cases of possible hypersensitivity reactions (one/98,400 doses or 137,787,500 IU), 7 with possible thromboembolic events (one/168,700 doses or 236,207,200 IU), 5 of possible inhibitor development (one/236,200 doses or 330,690,100 IU), and 20 of possible pathogen transmission (one/59,100 doses or 82,672,500 IU). 19 pathogen transmission cases involved viral infection; 4 could not be analyzed due to insufficient data, but for all others a causal relationship to the product was assessed as unlikely. A review of published literature revealed a similar safety profile. CONCLUSION Assessment of ADRs demonstrated that FXIII concentrate carries a low risk of ADRs across various clinical situations, suggesting a favorable safety profile.
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Affiliation(s)
- Cristina Solomon
- Medical Affairs Acquired Bleeding Disorders, CSL Behring, Marburg, Germany
| | - Wolfgang Korte
- Hemostasis and Hemophilia Center; and Center for Laboratory Medicine, St. Gallen, Switzerland
| | - Dietmar Fries
- Department of Anesthesia and Intensive Care, Medical University Innsbruck, Innsbruck, Austria
| | | | | | | | - Ingvild Birschmann
- Institute for Laboratory and Transfusion Medicine, Heart and Diabetes Center, Ruhr-University Bochum, Bad Oeynhausen, Germany
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Beyerle A, Solomon C, Dickneite G, Herzog E. Nonclinical analysis of the safety, pharmacodynamics, and pharmacokinetics of plasma-derived human FXIII concentrate in animals. Pharmacol Res Perspect 2016; 4:e00227. [PMID: 27069637 PMCID: PMC4804322 DOI: 10.1002/prp2.227] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 01/29/2016] [Accepted: 02/05/2016] [Indexed: 11/18/2022] Open
Abstract
Factor XIII (FXIII) is a coagulation protein which plays a major role in hemostasis by covalently cross‐linking fibrin molecules, thereby stabilizing the blood clot and increasing resistance to fibrinolysis. FXIII deficiency, either congenital or acquired, is associated with spontaneous bleeding, increased bleeding time, and poor wound healing. Purified plasma‐derived human FXIII concentrate (pd hFXIII) has been available since 1993 for therapeutic use in congenital FXIII deficiency. This set of nonclinical investigations aimed to evaluate the pharmacodynamic effects and assess the safety profile of pd hFXIII. The efficacy and safety of pd hFXIII were evaluated by pharmacodynamic, pharmacokinetic, and toxicity studies in mice and rats, safety pharmacology studies in dogs, neoantigenicity study, local tolerance, and thrombogenicity tests in rabbits. Administration of pd hFXIII resulted in the correction of deficits in clot formation kinetics and strength as measured by thromboelastometry, and was not associated with thrombus formation up to 350 IU/kg in FXIII knockout mice. There was no production of neoantigens resulting from the viral elimination manufacturing steps detected, and no adverse reactions were observed in toxicity studies with single doses up to 3550 IU/kg in mice and 1420 IU/kg in rats; nor from repeat doses of 350 IU/kg in rats. In addition, local tolerance tests revealed a good tolerability profile in rabbits. Overall, this data showed that pd hFXIII was well tolerated and pharmacodynamically active in preclinical animal models, supporting pd hFXIII as a therapy for FXIII deficiency.
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Affiliation(s)
- Andrea Beyerle
- CSL Behring GmbH Preclinical Research and Development Marburg Germany
| | - Cristina Solomon
- CSL Behring GmbH Medical Affairs Acquired Bleeding Disorders Marburg Germany
| | - Gerhard Dickneite
- CSL Behring GmbH Preclinical Research and Development Marburg Germany
| | - Eva Herzog
- CSL Behring GmbH Preclinical Research and Development Marburg Germany
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Biesenbach P, Eskandary F, Ay C, Wiegele M, Derfler K, Schaden E, Haslacher H, Oberbauer R, Böhmig GA. Effect of combined treatment with immunoadsorption and membrane filtration on plasma coagulation-Results of a randomized controlled crossover study. J Clin Apher 2015; 31:29-37. [DOI: 10.1002/jca.21399] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2014] [Revised: 03/22/2015] [Accepted: 04/06/2015] [Indexed: 12/29/2022]
Affiliation(s)
- Peter Biesenbach
- Division of Nephrology and Dialysis; Department of Medicine III; Medical University of Vienna; Vienna Austria
| | - Farsad Eskandary
- Division of Nephrology and Dialysis; Department of Medicine III; Medical University of Vienna; Vienna Austria
| | - Cihan Ay
- Division of Hematology and Hemostaseology; Department of Medicine I; Medical University Vienna; Vienna Austria
| | - Marion Wiegele
- Department of Anaesthesia; General Intensive Care and Pain Control, Medical University Vienna; Vienna Austria
| | - Kurt Derfler
- Division of Nephrology and Dialysis; Department of Medicine III; Medical University of Vienna; Vienna Austria
| | - Eva Schaden
- Department of Anaesthesia; General Intensive Care and Pain Control, Medical University Vienna; Vienna Austria
| | - Helmuth Haslacher
- Department of Laboratory Medicine; Medical University of Vienna; Vienna Austria
| | - Rainer Oberbauer
- Division of Nephrology and Dialysis; Department of Medicine III; Medical University of Vienna; Vienna Austria
| | - Georg A. Böhmig
- Division of Nephrology and Dialysis; Department of Medicine III; Medical University of Vienna; Vienna Austria
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Novel and recurrent mutations in the F13A1 gene in unrelated Korean patients with congenital factor XIII deficiency. Blood Coagul Fibrinolysis 2015; 26:46-9. [DOI: 10.1097/mbc.0000000000000171] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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