///2019 Abstract Details
2019 Abstract Details2019-07-13T07:45:15-05:00

Factor XI Deficiency in the Parturient: A Retrospective Review

Abstract Number: T2I-555
Abstract Type: Original Research

Migdalia H Saloum MD1 ; Julio E Marenco MD2; Barbara Orlando MD3; Deborah Stein MD4

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 in our health system. This screening test has identified a large number of patients, mostly heterozygotes, that had been otherwise asymptomatic for the disorder. 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 no clear consensus on the safe level of factor XI for neuraxial anesthesia placement. In addition, there is variability in the decision to transfuse FFP. We present a retrospective review of the anesthetic management of 25 patients with FXI deficiency. Of the 25 patients, 22 received neuraxial anesthesia. 10 patients delivered via cesarean section, and 15 patients delivered vaginally. The 3 patients that did not receive neuraxial had factor levels of 7%, 28% and 35% and delivered vaginally with remifentanil PCA or nitrous oxide for analgesia. Of the 22 patients that received neuraxial, 11 patients where in the mild range (near 50%), and 13 patients were in the mild/moderate range (20-50%). None of the 11 patients in the mild range received FFP transfusion, while 6 of the 13 patients in the mild/moderate (20-50%) group received transfusions. It's evident that this mild/moderate deficiency population presents the most challenges, as it is unclear what their obstetric hemorrhage and/or epidural hematoma risk is. therefore, there is more variability in management. 6 patients received FFP during their labor, ranging from 1 to 3 units. The patients that received FFP had 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 and received neuraxial anesthesia had factor levels of ranging from 35% - 71%. Interestingly, the lowest factor level to receive neuraxial without a transfusion was 35%, while another patient with the same factor level was given nitrous oxide for delivery. It is evident that there is significant variability in the management of patients with mild/moderate FXI deficiency. Influencing variables include patient antepartum consultation with a hematologist, differences in recommendations by consulting hematologists, antepartum anesthesia consult, 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 2019