Acquired Factor Xiii Deficiency: An Uncommon But Easily Missed Cause Of Severe Bleeding

Factor XIII (FXIII) is a plasma clotting protein involved in clot stabilization. Severe FXIII deficiency may present with severe, even fatal bleeding. Critically however, routine coagulation assays may be normal and only specific FXIII assays will detect the abnormality. Herein we discuss a case report of a patient with acquired FXIII deficiency in order to highlight the clinical challenges associated with establishing the diagnosis and discuss the treatment approach. A 70-year-old man presented with a gluteal haematoma despite no preceding personal history of bleeding. Extensive initial haemostatic investigations were normal until a specific FXIII assay showed a marked reduction in FXIII levels. With directed treatment, bleeding episodes ceased and remission was achieved. Clinical awareness of FXIII deficiency is important, so appropriate testing can be implemented in patients with unexplained bleeding diatheses, particularly those in whom bleeding responds poorly to standard replacement therapy.

Contractor perspective of the new Irish public works contracts

Traditionally in Ireland the forms of contract used for government-funded projects were those published by either the Institution of Engineers of Ireland or the Royal Institute of the Architects of Ireland. They were based on the Institution of Civil Engineers and Joint Contracts Tribunal standard forms with minor changes to reflect local conditions. In 2007 the Irish government introduced a suite of bespoke contract forms for both employer-designed and contractor-designed projects. Although officially entitled ‘public works contracts’ they are colloquially known as the GCCC contracts after the Government Construction Contracts Committee, the body within the Irish Department of Finance responsible for drafting and introducing them. The new forms are fixed-price lump-sum contracts with considerably more construction risk transferred to contractors than under the previous forms. The forms are now mandatory for all new building and civil engineering infrastructural projects and many contractors have complained that some of the risks transferred are not only inappropriate but are incapable of assessment at tender stage. The paper sets out the history of the development of the new forms and provides an overview of the more contentious provisions.