Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2021.08.024
Brazilian Journal of Anesthesiology
Case Report

Anesthesia strategy for factor X deficiency coagulopathy: case report

Estratégia anestésica em coagulopatia de deficiência de fator X: relato de caso

Carla Isabel Ferreira, Fábio Costa, Ana Rita Arantes, Graça Horta, Elsa Soares, Filipa Félix

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Abstract

Factor X deficiency ranks among the rarest coagulopathies and has a variable presentation spectrum. We intend to present a proposal for anesthesia protocol for individuals with the coagulopathy. The excision of an ovarian neoplasm was proposed for a 26-year-old, female, ASA II patient, with congenital Factor X deficiency. Physical examination and lab tests were normal, except for Prothrombin Time (PT) 22.1s (VR: 8–14s), International Normalized Ratio (INR) 1.99 (VR: 0.8–1.2) and Activated Partial Thromboplastin Time (aPTT) 41.4s (VR: 25–37s). We concluded that a history of bleeding should always be investigated, along with a pre-anesthetic coagulation study.

Keywords

Factor X;  Anesthesia;  Management

Resumo

A deficiência do Fator X é uma das coagulopatias mais raras e tem um espectro de apresentação variável, e pretendemos apresentar uma proposta de protocolo anestésico para portadores dessa coagulopatia. Uma paciente de 26 anos, sexo feminino, ASA II, portadora de défice congênito de Fator X, foi proposta para excisão de neoplasia do ovário. Seus exames físico e laboratoriais não revelaram alterações, exceto o Tempo de Protrombina (PT) 22,1 s (VR:8–14s); Internacional Normalized Ratio (INR) 1,99 (VR:0,8–1,2) e o Tempo de Tromboplastina Parcial Ativada (aPTT) 41,4 s (VR:25–37 s). Constatamos que os antecedentes hemorrágicos devem ser sempre investigados, assim como o estudo da coagulação na investigação pré-anestésica.

Palavras-chave

Fator X; Anestesia; Manuseamento

References

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2 M Menegatti, F. Peyvandi Factor X deficiency Semin Thromb Hemost, 35 (2009), pp. 407-415

3 A. Shapiro Plasma-derived human factor X concentrate for on-demand and perioperative treatment in factor X-deficient patients: pharmacology, pharmacokinetics, efficacy, and safety Expert Opin Drug Metab Toxicol, 13 (2017), pp. 97-104

4 MA Escobar, G Auerswald, S Austin, JN Huang, M Norton, CM Millar Experience of a new high-purity factor X concentrate in subjects with hereditary factor X deficiency undergoing surgery Haemophilia, 22 (2016), pp. 713-720

5 NSP Módolo, VLF De Azevedo, PSS Santos, ML Rosa, DR Corvino, LJS. Castro Alves Anesthetic strategy for Cesarean Section in a patient with factor XI deficiency. Case report Rev Bras Anestesiol, 60 (2010), pp. 176-180

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