Akademik Veri Yönetim Sistemi
Anestezi Dergisi, cilt.31, ss.156-157, 2023 (Scopus)
Background: Hemophilia C, which develops as a result of deficiency of Factor XI, is a rare coagulation disorder and was first described by Rosenthal in 1953. Spontaneous bleeding is rare in patients, severe bleeding may occur as a result of surgery and trauma. Hemorrhage is seen mostly in the oral and nasal mucosa and urogenital system, where fibrinolytic activity is high. Case: In this case, we aimed to present the management of cesarean section anesthesia in a patient with Factor XI deficiency in the light of the literature. 31 years old, 85 kg, 36 weeks pregnant, gravida 2, para 1, was planned for elective cesarean section. In the preoperative evaluation, the patient with hypothyroidism was medicated levothyroxine 75 mcg day-1 and diagnosed hemophilia C. The American Society of Anesthesiologists' score was 2, and the Mallampati score was 2. No spontaneous bleeding, but menorrhagia also heavy bleeding during dental treatment were been in her history. The patient had been operated for cholecystectomy and cesarean section with fresh frozen plasma before these operations and no exessive bleeding was encountered. The preoperative laboratory parameters of the patient were aPTT 75.3 sec, INR 0.98, platelet count 150.000 ul-1, hemoglobin 11.9 g dl-1. In consultation with the Hematology department before the operation, 1 unit of fresh frozen plasma (FFP) was replaced. After the replacement, aPTT value was seen as 40.8 seconds, the patient was taken to the operation. Tranexamic acid 1 gr IV and 1 unit of FFP were administered intraoperatively. On the 3rd postoperative day, the aPTT value increased to 60.4 seconds, re-replacement was not planned with the recommendation of the Hematology department. The patient was discharged on the 4th postoperative day. Conclusion: Clinically, spontaneous bleeding is rare and routinary treatment is not necessary, but the risk of bleeding may always be assessed according to the characteristics of the surgery. There are cases in the literature who underwent neuraxial anesthesia, and an increase in postpartum bleeding rates was reported in the cohort study. Bleeding management should be performed in the patient with hemophilia C with a multidisciplinary approach consisting of an anesthesiologist, hematologist and obstetrician.