Erfassung eines Faktor-XIII-Mangels mit der Thrombelastometrie

Abstract

While undergoing Whipple's operation (pancreaticoduodenectomy) a patient developed diffuse bleeding and an unexpectedly high blood loss. An intraoperatively performed thrombelastometry with ROTEM (Pentapharm, Munich, Germany) showed an aprotonin-resistant mild fibrinolysis and suggested the presence of an isolated deficiency of coagulation factor XIII. This was confirmed by a second thrombelastometry, where no lysis was seen after in vitro substitution of factor XIII. After administration of 1250 IU factor XIII concentrate the diffuse bleeding ceased and further substitution of coagulation factor concentrates or fresh frozen plasma was not necessary. A postoperatively performed analysis confirmed the factor XIII deficiency (52%).

Thromboelastometric detection of clotting Factor XIII deficiency in cardiac surgery patients

“…Several authors have described alterations in ROTEM which indirectly refer to decreased Factor XIII plasma levels. Weber and colleagues found aprotinin‐resistant hyperfibrinolysis in APTEM which vanished after in vitro addition of 0·2 IU Factor XIII [(Weber et al , ) in one case, emphasising the fact, that there is a poor correlation between ML EXTEM and the extend of Factor XIII deficiency]. A similar statement was made by Goerlinger ().…”

“…To restore Factor XIII level in the ROTEM-probe (cuvette volume approximately 3 mL), we calculated the required dose as 0.625 IU. Additionally, the dosage of Factor XIII used in this study is nearly equivalent to other studies dealing with this topic (Weber et al, 2008). Furthermore, the dose for Factor XIII substitution ex vivo cannot be calculated only with reference to the volume of blood in the cuvettes (300 μL), as the ingredients of EXTEM exceed this volume.…”

“…In this observational study, we compared the ROTEM analysis in cardiac surgery patients post-operatively and 6 h later, at first with the 'native' EXTEM test to detect any coagulation disorder, especially a decreased MCF (De Nicola & Spreafico, 1966;McDonagh et al, 1969;Tyler, 1969;Abels et al, 1970;Francis, 1980;Calatzis et al, 1999;Jambor et al, 2009) and/or increased ML (Goerlinger, 2006;Weber et al, 2008). Moreover, we launched EXTEM (post-operatively and 6 h) with ex vivo administration of Factor XIII into the assay (= teenTEM).…”

“…Others described relationships between Factor XIII plasma levels and ROTEM acquired variables, such as clot formation time (CFT), MCF and maximum lysis (ML) (Jambor et al , ; Theusinger et al , ). Case reports were published demonstrating restoration of aprotinin‐resistant fibrinolysis in APTEM in addition of Factor XIII in vitro (Goerlinger ; Weber et al , ). These investigators showed that deranged coagulation could be restored in vitro by adding Factor XIII to the test performed.…”

Reduction of Fresh Frozen Plasma Requirements by Perioperative Point-of-Care Coagulation Management with Early Calculated Goal-Directed Therapy

“…In particular, factor XIII administration should be considered in neurosurgical and tumour patients with an activity of factor XIII below 60%, in bleeding patients with increased clot lysis in ROTEM analysis not responding to antifibrinolytics but to in vitro spiking with factor XIII, in ongoing bleeding without pathological findings in ROTEM and Multiplate analysis, and in repeated postoperative diffuse bleeding without detectable surgical source of bleeding [15,18,19,36,51,52,55,62,[83][84][85][86][87][88][89][90][91][92][93].…”