Thromboelastometry guiding anesthetic and coagulation management of cesarean delivery in a parturient with factor V deficiency

Published:September 01, 2022DOI:
      Inherited Factor V (FV) deficiency is a rare but challenging bleeding disorder particularly in the context of pregnancy. A 26-year-old pregnant woman, (gravida 2, para 1) was admitted at 38 weeks’ gestation for elective cesarean delivery (CD) for obstetric reasons. The FV deficiency had been discovered during a postpartum hemorrhage (PPH) in her first pregnancy. Laboratory tests performed before the elective CD showed a prothrombin time (PT) of 23% and activated partial thromboplastin time (aPTT) of 60 s, giving a patient/control ratio of two. The FV level was 4% and other clotting factors levels were normal. The anti-FV antibody titre was negative.
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        • Maeda K.
        • Kaji T.
        • Nakayama S.
        • et al.
        Pregnancies with factor V deficiency: a case report and review of the literature.
        Clin Exp Obstet Gynecol. 2017; 44: 299-300
        • Bolton-Maggs P.H.B.
        • Perry D.J.
        • Chalmers E.A.
        • et al.
        The rare coagulation disorders–review with guidelines for management from the United Kingdom Haemophilia Centre Doctors' Organisation.
        Haemophilia. 2004; 10: 593-628
        • Huang J.N.
        • Koerper M.A.
        Factor V deficiency: a concise review.
        Haemophilia. 2008; 14: 1164-1169
        • Drzymalski D.M.
        • Elsayes A.H.
        • Ward K.R.
        • House M.
        • Manica V.S.
        Platelet transfusion as treatment for factor V deficiency in the parturient: a case report.
        Transfusion. 2019; 59: 2234-2237
        • Bell S.F.
        • Collis R.E.
        • Bailey C.
        • et al.
        The incidence, aetiology, and coagulation management of massive postpartum haemorrhage: a two-year national prospective cohort study.
        Int J Obstet Anesth. 2021; 47102983
        • Spiezia L.
        • Radu C.
        • Campello E.
        • et al.
        Whole blood rotation thromboelastometry (ROTEM(®)) in nine severe factor V deficient patients and evaluation of the role of intraplatelets factor V.
        Haemophilia. 2012; 18: 463-468
        • Le Gouez A.
        • Roger-Christoph S.
        • Abbes M.
        • Benhamou D.
        Anesthetic management of parturients with defects in coagulation factor V.
        Int J Obstet Anesth. 2011; 20: 97-98
        • Dunkley S.
        • Curtin J.A.
        • Marren A.J.
        • Heavener R.P.
        • McRae S.
        • Curnow J.L.
        Updated Australian consensus statement on management of inherited bleeding disorders in pregnancy.
        Med J Aust. 2019; 210: 326-332
        • Mathias M.
        • Tunstall O.
        • Khair K.
        • Liesner R.
        Management of surgical procedures in children with severe FV deficiency: experience of 13 surgeries.
        Haemophilia. 2013; 19: 256-258
        • Levy-Mendelovich S.
        • Barg A.A.
        • Rosenberg N.
        • et al.
        Treatment tailoring for factor V deficient patients and perioperative management using global hemostatic coagulation assays.
        Blood Cells Mol Dis. 2018; 71: 5-10