Complete hemostasis achieved by factor XIII concentrate administration in a patient with bleeding after teeth extraction as a complication of aplastic anemia and chronic disseminated intravascular coagulation

Abstract

 

Hemostatic treatment of disseminated intravascular coagulation (DIC) due to aortic aneurysm involves numerous difficulties. An 89-year-old man with aplastic anemia and chronic DIC developed periodontitis and loose teeth requiring extraction, after which hemostasis was difficult. Platelet concentrates and fresh-frozen plasma transfusions were ineffective, and there was a risk of hemorrhage; therefore, administration of anticoagulant agents for DIC was inappropriate. A decrease in factor XIII (FXIII) was discovered, and FXIII concentrate was administered, resulting in hemostasis together with wound healing. No complications were seen, but the following coagulation markers were found to decrease: fibrin degradation products, d-dimer, thrombin–antithrombin complex, and plasmin-α₂ plasmin inhibitor complex. By 1 month after FXIII administration, FXIII had returned to the preadministration level, thus, the FXIII decrease was deduced to be have been due to DIC. These findings suggest that FXIII concentrate is useful for treating hemorrhage associated with DIC due to aortic aneurysm.