79-jähriger Patient mit bedrohlicher Blutung nach Darmoperation bei normalen globalen Gerinnungsparametern

Abstract

We report the case of a 79-year-old Caucasian male, who underwent anterior resection of the rectum for treatment of a colorectal carcinoma. Two days after the surgery, the patient had mild but persistent haemorrhage from all drains and around the wounds which eventually required blood transfusion (18units of erythrocyte concentrate and 8units of fresh-frozen plasma). Endoscopy revealed no surgical bleeding source, and standard coagulation tests were inconspicuous. Based on suspicion of factorXIII deficiency, the patient was treated with factorXIII concentrate (1250I.U. injections twice daily), starting on day4 of bleeding. The bleeding stopped after the second dose of factorXIII. Laboratory testing retrospectively revealed the lack of factorXIII (43 % at the first day of dosing). FactorXIII concentrate was administered for 10days. Withdrawal of factor XIII after 9days of treatment led to a bleeding recurrence. After resuming treatment for one more day, the therapy could be stopped without further bleeding. Thus, factorXIII deficiency should be considered in patients with unexplained postoperative bleeding and appropriate diagnostic measures be taken early. In cases of medical emergency, probative administration of factorXIII may be justified.