REVIEW   

Minerva Anestesiologica 2022 March;88(3):156-65

DOI: 10.23736/S0375-9393.22.15772-X

Copyright © 2022 EDIZIONI MINERVA MEDICA

language: English

Factor XIII and surgical bleeding

Patricia GUILABERT ¹ ✉, Lars ASMIS ², Vicente CORTINA ³, Joan P. BARRET ⁴, Maria J. COLOMINA ⁵

¹ Department of Anesthesia and Critical Care, Vall d’Hebron University Hospital, Autonomous University of Barcelona, Barcelona, Spain; ² University of Zurich, Center for Perioperative Thrombosis and Hemostasis, Zurich, Switzerland; ³ Hemostasis Laboratory, Vall d’Hebron University Hospital, Barcelona, Spain; ⁴ Department of Plastic Surgery and Burn Center, Vall d’Hebron University Hospital, Autonomous University of Barcelona, Barcelona, Spain; ⁵ Department of Anesthesia and Critical Care, Bellvitge University Hospital, University of Barcelona, Barcelona, Spain

Factor XIII (FXIII) is the final factor in the coagulation cascade. It converts soluble fibrin monomers into a stable fibrin clot, prevents premature degradation of fibrin, participates in wound healing, and helps prevent the loss of the endothelial barrier function. FXIII deficiency is believed to be rare, and this may explain why clinicians do not routinely take it into consideration. Congenital FXIII deficiency is a rare disease with a reported prevalence of 1 per million. However, the prevalence of acquired FXIII deficiency is much higher. Acquired forms have been described in patients with decreased hepatic or bone marrow synthesis, overconsumption and increased degradation by autoantibodies. This review offers guidance on how to suspect and diagnose FXIII deficiency in both the preoperative consultation and different surgical settings. We also analyze current scientific evidence in order to clarify when and why this clinical situation should be suspected, and how it may be treated.

KEY WORDS: Factor XIII; Hemorrhage; Blood coagulation factors; Blood coagulation disorders; Blood coagulation tests