Costco Pharmacy Celexa Lipitor Sale Us Buy Viagra Ebay Black Cialis E Check F Where To Buy Nizoral Online

///2018 Abstract Details
2018 Abstract Details2019-08-02T15:57:01-05:00

Factor XI deficiency: A Case Series

Abstract Number: T1D-6
Abstract Type: Case Report/Case Series

Migdalia H Saloum MD1 ; Julio E Marenco MD2; Jason J White MD3; Barbara Orlando MD4; Stein Deborah MD5

Factor XI (FXI) deficiency is a rare inherited coagulation disorder. The number of patients presenting to labor and delivery with FXI deficiency has significantly increased, mainly due to an antenatal screening test. As opposed to other hemophilias, FXI deficiency is not a well characterized coagulation disorder and has a variable bleeding phenotype. There is poor correlation between factor levels and bleeding, which presents a clinical challenge, especially in the consideration of neuraxial anesthesia. There is a paucity of literature on FXI deficiency in obstetric anesthesia, and there is no consensus on the safe level of factor XI necessary for neuraxial anesthesia. We present a retrospective review of a series of 14 patients with FXI deficiency that have presented to our labor and delivery unit. In general, <15% is considered to be a severe homozygous deficiency, while near 50% is considered mild. Of the 14 patients, none had a severe homozygous deficiency. 8 patients where in the mild range (51 – 63%),and 6 patients were mild to moderate (28-42%). It is this mild to moderate range that presents the most challenges in anesthetic management, as it is unclear what their obstetric hemorrhage and/or epidural hematoma risk is. Since FXI levels do not necessarily correlate with bleeding, it is difficult to predict hemorrhage based solely on the factor level. In addition, history of bleeding is not always reliable as there may not have been an adequate hemostatic challenge. There have not been any neurological complications or obstetric hemorrhages in any of our patients to date. All but 1 received neuraxial anesthesia. The 1 patient that didn't receive neuraxial had the lowest factor level (28%), and thus received transfusion of FFP and was managed with remifentanyl PCA for her vaginal delivery. 6 of the 14 patients delivered via c-section; 2 of those c-sections were scheduled, whereas the remaining 4 were emergency cesarean deliveries. 6 patients received FFP during their labor, ranging from 1 to 3 units. The patients that received FFP had presenting factor levels of 28% (no neuraxial), 38%, 41%, 33%, 38%, and 31%The lowest factor level that received neuraxial anesthesia (spinal) was 31% and was delivered via cesarean section after transfusion of 3 units FFP. The patients that did not receive FFP transfusion and were managed with neuraxial anesthesia had factor levels of 42%, 54%, 58%, 50%, 51%, 55%, 35%, and 63%. It is evident that there is variability in the decision to transfuse FFP in these patients with mild to moderate factor deficiency. One factor is the differences in opinions of the consulting hematologists that evaluated these patients.Additional variables in management were the patient’s previous bleeding history and obstetrical delivery plan. Gomez K: FXI deficiency. Haemophilia 2008.14,1183-1189.Singh A, Harnett MJ, Connors JM, Camann WR: FXI Deficiency and Obstetric Anes. A&A 2009

SOAP 2018