You Made the Call
Follow her and let her deliver normally. No medical
intervention is necessary.
Anjali A. Rathkumar, MD
Iowa City, IA
I would just follow her; recombinant FXI would also
be advised. Although there is variability in bleeding
tendencies in FXI deficiencies, I would aim for 50
percent or more around the time of delivery.
Kim Ma, MD
McGill University
Montreal, Canada
We asked, and you answered! Here are a few responses
from this month’s “You Make the Call.”
I would just observe the patient and use FFP depending
on levels of FXI or if there’s bleeding.
Siria Carvajal Lohr, MD
Mexico City, Mexico
For the full description of the clinical dilemma, and to
see how the expert responded, turn to page 46.
Clinical Dilemma:
I have a pregnant 38-year-old female patient with factor
XI (FXI) deficiency. She has never had any heavy menstrual
complaints and has had surgery and wisdom teeth
extraction with no excess bleeding. No one in her family
has bleeding problems or is known to have FXI deficiency.
FXI runs 39-55 percent so far. I was thinking of observation
and reserving fresh frozen plasma (FFP) for bleeding.
I recommend following the patient, with FXI available
but not transfused unless she starts bleeding or her
level changes at time of labor.
If the patient never bled, I’d be prepared for any
bleeding problem, but I wouldn’t use FFP or
prothrombin complex.
Sergio Gomez, MD
Hospital de Niños Sor María Ludovica
Buenos Aires, Argentina
The patient should be observed, with FFP reserved
for any episodes of serious bleeding — which she is
unlikely to have.
William F. Kern, MD
University of Oklahoma Health Sciences Center
Oklahoma City, OK
This is becoming a more common occurrence with genetic
screening. Given the lack of a family or personal history
of bleeding, she does not need any treatment during
her pregnancy. She should be tested for von Willebrand
disease (if that was not already done) since the two can
coexist. She should not have an epidural if her FXI level
is low and her activated partial thromboplastin time is
prolonged. If she has a male baby, the FXI level should be
checked from a cord sample.
Eugene Reese, MD
Jackson, TN
Randy L. Levine, MD
Lenox Hill Hospital
New York, NY
Do nothing except clinical follow-up of her pregnancy.
Samar A. Muwakkit, MD
American University of Beirut Medical Center
Beirut, Lebanon
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