2021 Volume 2 Issue 2 Pages 54-58
Factor XIII, also called the fibrin-stabilizing factor, is the last clotting factor in the second stage of coagulation. Postoperative hemorrhage caused by factor XIII deficiency occurs with a delay of a few days and may be lethal, depending on the intensity of bleeding. Prompt diagnosis and treatment interventions are critical for preventing fatal outcomes. There are two types of factor XIII deficiency: congenital and acquired. While the congenital type is usually diagnosed early in relation to bleeding from the umbilical cord, the acquired type manifests during adulthood and may be caused by various factors. One is the increased consumption of factor XIII during trauma and surgery. All routine preoperative coagulation tests are normal in this condition, causing its diagnosis before an operation difficult.
We report a case of acquired factor XIII deficiency that manifested as massive hemorrhage on the first postoperative day after breast reconstruction with a deep inferior epigastric perforator flap. This paper aims to alert plastic surgeons on the condition, since awareness is critical to initiate immediate and effective treatment. We suggest that if surgeons encounter incomprehensible postoperative delayed hemorrhage, verification of factor XIII activity must be promptly done to diagnose factor XIII deficiency and avoid lethal hemorrhage.
