Abstract
We report two cases of acquired factor XIII deficiency with bleeding events during veno-venous extracorporeal membrane oxygenation (ECMO). Case 1: A 76-year-old man diagnosed with aspiration pneumonia after near-drowning was started on ECMO. Later, the patient presented with hemoptysis and anemia. Blood tests showed a decreased factor XIII activity of 29%. Although the patient recovered after receiving 1200 International Units of factor XIII concentrate, the patient had another episode of decreased factor XIII activity and bloody stool and was treated again with factor XIII concentrate. Case 2: A 48-year-old female diagnosed with pneumonia was started on ECMO. Soon after, she presented with hemoptysis and anemia. Blood tests showed a decreased factor XIII activity of 39%. The patient was treated with 720 IU of factor XIII concentrate with good recovery. Acquired factor XIII deficiency cannot be detected by routine coagulation tests, therefore it may be under-diagnosed in the ICU. Detection of acquired factor XIII deficiency is essential when treating a bleeding ECMO patient.
Highlights
We report two cases of acquired factor XIII deficiency with bleeding events during extracorporeal membrane oxygenation (ECMO), treated successfully with factor XIII concentrate
This case highlights the following two important clinical insights: (1) Acquired factor XIII deficiency cannot be detected by routine coagulation tests, thereby uncontrollable bleeding should be considered highly suspicious despite normal routine coagulation tests
Severe bleeding events that occur during VV-ECMO treatment are critical and may potentially impact the odds of survival
Summary
Veno-venous (VV) extracorporeal membrane oxygenation (ECMO) can be a successful treatment for certain patients. We report two VV-ECMO patients with uncontrollable bleeding events and acquired factor XIII deficiency, who were successfully treated with factor XIII concentrate. The patient improved and was weaned off of ECMO on the 5th day. The patient received 1200 International Units (IU) of factor XIII concentrate, by which clinical symptoms and blood tests promptly recovered, with a factor XIII activity of 115% after treatment. A few days later, the patient had another bleeding episode of bloody stool This time factor XIII activity was 31%, which recovered to 107% after the same dose of factor XIII concentrate. The patient received 720 IU of factor XIII concentrate for 7 days, whereupon factor XIII activity improved to 115% along with improvement of clinical symptoms. The patient’s clinical course and coagulation data are shown
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