Management of cardiopulmonary bypass in a patient with congenital factor XII deficiency

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ACTOR XII, also known as Hagemann factor, is the F first enzyme in the intrinsic pathway of the clotting cascade. Patients with a congenital Factor XII deficiency demonstrate laboratory abnormalities but are not at risk for bleeding diatheses.’ The activated coagulation time (ACT) is prolonged in these patients and is, thus, of little value for monitoring the adequacy of anticoagulation during cardiopulmonary bypass (CPB). This report describes the management of a patient with a congenital deficiency of Factor XII who presented for coronary artery bypass grafting (CABG). All three bypass grafts thrombosed shortly after separation from CPB and heparin reversal, suggesting a Factor XII associated hypercoagulability. Further complicating this patient’s management was prolonged preoperative heparin therapy and the potential for heparin resistance, making estimation of anticoagulation requirements even more problematic.