Factor X Deficiency Management for Elective Cesarean Delivery in a Pregnant Patient

Abstract

Rare co-existance of disease or pathology Background:Congenital factor X deficiency is a rare inherited coagulopathy. Pregnancies in women with this disorder are often associated with adverse outcomes, including miscarriage, premature labor, and hemorrhage during pregnancy and in the peripartum period. The literature on this disorder is sparse and shows a limited number of successful pregnancies in women with factor X deficiency. Case Report:In this report, we present the case of a successful pregnancy and term delivery by elective cesarean section in a 39-year-old primigravida with congenital factor X deficiency. Medical management followed the recommendations of an interdisciplinary team comprising specialists in obstetrics, anesthesia, transfusion medicine, hematology, and neonatology. This high-risk pregnancy was successfully brought to term, and a healthy male neonate was delivered by elective cesarean section at 39 weeks' gestation. The patient's factor X deficiency (0.19 kIU/L) was treated using 4 units of solvent-detergent-treated fresh frozen plasma (SD-FFP) 1 h before the cesarean section, leading to hemostatic levels of factor X and an uneventful intraoperative course. Postoperatively, the patient's factor X levels were controlled daily and corrected using SD-FFP as needed, with no clinically significant blood loss. Conclusions:SD-FFP can be used to manage congenital factor X deficiency in the peripartum period and maintain perioperative blood loss within normal limits.

Management of rare inherited bleeding disorders: Proposals of the French Reference Centre on Haemophilia and Rare Coagulation Disorders

“…FFP (15–25 mL/kg) may be an alternative if PCC is not available. Coagadex® (plasma‐derived FX concentrate) can be used to increase the plasma FX level to 20–50 IU/dL 48 …”

“…Coagadex ® (plasma-derived FX concentrate) can be used to increase the plasma FX level to 20-50 IU/dL. 48…”

Role of Genetics in Anesthesiology

“…The American Society of Anesthesiologists (ASA) Task Force on perioperative blood Management declares that FFP indicates or improves excessive microvascular bleeding conditions. 12…”

Network Pharmacology‐Based Prediction of Active Ingredients and Potential Targets of ShengDiHuang Decoction for Treatment of Dysfunctional Uterine Bleeding

“…F10, Factor X, is a vitamin K-dependent glycoprotein and also a pivotal coagulation factor in the common coagulation pathway that converts prothrombin to thrombin in the presence of factor Va, calcium, and phospholipid during blood clotting [39]. Factor X deficiency (FXD) is a rare coagulation with manifestation of variable severity and usually increase the risk of bleeding complications [40]. It is reported that heavy menstrual bleeding (HMB), recurrent ovulation bleeding with hemoperitoneum, and bleeding complications in pregnancy are more common in women [41].…”