hemoglobin count 10.6 g/dl. Prothrombin time (PT) was 100% (normal range: 70%-100%), activated partial thromboplastin time (APTT) with normal plasma [ratio 1:1] was 1.24 (Normal range: 0.80-1.20). Her laboratory evaluation revealed an FXI level quantitated at 41%.A routine hematology consultation was obtained and a bleeding management strategy was established that was performing the surgical procedure with antifibrinolytic therapy with tranexamic acid (1 g twice a day, for 10 days), avoid nonsteroidal antiinflammatory and use of Factor XI concentrates (Hemoleven®, LFB) only if bleeding.The surgery was done without any problem, bleeding was about 200 mL and no transfusion was needed.The patient remained in the post-anaesthesia care unit for 80 minutes and then returned to her hospital room. She was discharged from the hospital the day after surgery. No adverse events have been reported. Case 2White French female patient, 33-years-old, 56 kg, 156 cm was scheduled for a tubal ligation. Vital signs (blood pressure, temperature, oxygen saturation and Glasgow coma score) were normal. His ASA physical status was 2, her treatment was Levothyroxine 75 µg. Past medical history found a hypothyroidism. Past surgical history consisted of two deliveries without complication, bilateral inguinal hernia, appendectomy, tonsillectomy without problem. A wisdom teeth extraction done in 2016 presented a hemorrhagic complication and laboratory evaluation found a factor

Background Disease progression in COPD patient is associated to lung function decline, leading to a higher risk of hypoxaemia and associated comorbidities, notably cardiovascular diseases (CVD). Adiponectin (Ad) is an adipokine with cardio-protective properties. In COPD patients, conflicting results were previously reported regarding Ad plasmatic (Adpl) level, probably because COPD is a heterogeneous disease with multifactorial influence. Among these factors, gender and hypoxaemia could interact in a variety of ways with Ad pathway. Therefore, we postulated that these components could influence Adpl level and its multimers in COPD patients and contribute to the appearance of a distinct endotype associated to an altered CVD risk. Methods One hundred COPD patients were recruited: 61 were men and 39 were women. Patients who were not severely hypoxemic were allocated to non-hypoxemic group which included 46 patients: 27 men and 19 women. Hypoxemic group included 54 patients: 34 men and 20 women. For all patients, Adpl level and proportion of its different forms were measured. Differences between groups were evaluated by Rank-Sum tests. The relationship between these measures and BMI, blood gas analysis (PaO2, PaCO2), or lung function (FEV1, FEV1/FVC, TLCO, TLC, RV) were evaluated by Pearson correlation analysis. Results Despite similar age, BMI and obstruction severity, women had a higher TLC and RV (median: TLC = 105%; RV = 166%) than men (median: TLC = 87%; RV = 132%). Adpl level was higher in women (median = 11,152 ng/ml) than in men (median = 10,239 ng/ml) and was negatively associated with hyperinflation (R = − 0,43) and hypercapnia (R = − 0,42). The proportion of the most active forms of Ad (HMW) was increased in hypoxemic women (median = 10%) compared with non-hypoxemic women (median = 8%) but was not modulated in men. Conclusion COPD pathophysiology seemed to be different in hypoxemic women and was associated to Ad modulations. Hyperinflation and air-trapping in association with hypercapnia and hypoxaemia, could contribute to a modulation of Adpl level and of its HMW forms. These results suggest the development of a distinct endotypic presentation, based on gender.

Background: Disease progression in COPD patient is associated to lung function decline, leading to a higher risk of hypoxaemia and associated comorbidities, notably cardiovascular diseases (CV). Gender is also known to influence CV risk. Adiponectin (Ad), a cardio-protective hormone, was suggested as a biomarker for COPD risk management. However, determinants and consequences of Ad pathway modulation in COPD are unknown and gender specificities are poorly understood. We postulated that hypoxaemia and gender could influence Ad pathway and contribute to the appearance of a distinct endotype associated to an altered CV risk.Methods: The Ad plasmatic (Adpl) level and proportion of its different forms were evaluated in hypoxemic and non-hypoxemic COPD men or women. The relationship between these measures and BMI, blood gas analysis (PaO2, PaCO2), or lung function (FEV1, FEV1/FVC, TLCO, TLC, RV) were tested.Results: Despite similar age, BMI and obstruction severity, women had a higher TLC and RV than men. Adpl level was higher in women and negatively associated with hyperinflation and hypercapnia. The proportion of the most active forms of Ad (HMW) is increased in hypoxemic women but not in men. A positive correlation between TLCO and HMW form proportion was observed in hypoxemic men, whereas a negative correlation was detected in non-hypoxemic men.Conclusion: Physiopathology of COPD seems to be gender specific. Hypoxaemia, hypercapnia and hyperinflation are associated to gender-specific Ad pathway alterations. Given CV properties of Ad, the impact of such modulation on co-morbidities development have to be considered in future studies.

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