Factor XIII deficiency leading to a life-threatening intracranial hemorrhage in a young female: a case report

Author:

Poombal FNU1,Fayyaz Hafiz Noor Ullah2,Saeed Hira3,Adhikari Sugat4

Affiliation:

1. Department of Pathology, Nishtar Medical University, Multan

2. Department of Medicine, Quaid-e-Azam Medical College, Bahawalpur

3. Department of Pathology, Federal Medical College, Islamabad, Pakistan

4. Shreegaun Primary Health Care Center, Dang, Nepal

Abstract

Introduction and importance: Factor XIII (FXIII) deficiency, a rare coagulation disorder resulting from F13A1 gene mutations, can lead to severe bleeding episodes, especially in infants. The authors’ case study featuring a 16-year-old female with a history of this deficiency revealed intracranial hemorrhage necessitating immediate medical intervention. The text emphasizes the importance of understanding the epidemiology and genetics of FXIII deficiency, as well as the challenges in diagnosis and management. Case presentation: A 16-year-old female with FXIII deficiency presented to the Emergency Department (ER) after a fall, experiencing weakness on her right side, headache, seizures, and altered consciousness. Neurological examination showed weakness and increased tone on the right side of the body. Computed tomography (CT) scan revealed an intracranial subdural hemorrhage overlying the superior parietal lobe. Treatment included IV fluids, sodium valproate, antibiotics, fresh frozen plasma, and mannitol. Serial neurological assessments were normal, and the patient remained stable. MRI later confirmed hemorrhage. Upon discharge, she was prescribed medication and physiotherapy, leading to significant improvement at the 6-month follow-up. Clinical discussion: The prevalence of FXIII deficiency, a rare disorder, is higher in populations with consanguineous marriages, particularly in regions like Pakistan, India, Tunisia, Finland, and Iran due to specific genetic mutations. Diagnosis involves thorough evaluation and specific lab tests, with varied clinical symptoms including prolonged bleeding, especially in newborns. FXIII deficiency can also develop in association with conditions like hepatic failure and leukemia, complicating diagnosis. Treatment options include blood products and recombinant FXIII, with management of intracranial bleeding requiring a multidisciplinary approach. Conclusion: The case underscores the critical need for early identification and specialized care for individuals with FXIII deficiency to mitigate life-threatening complications like intracranial hemorrhage, promoting tailored treatment approaches and improved patient outcomes.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Reference15 articles.

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2. Etiology and risk factors of stroke in young adults: a multicentric study;Aslam;Ann Med Surg,2022

3. Central nervous system bleeding in pediatric patients with factor XIII deficiency: a study on 23 new cases;Naderi;Hematology (Amsterdam, Netherlands),2015

4. Subunit antigen and activity levels of blood coagulation factor XIII in healthy individuals. Relation to sex, age, smoking, and hypertension;Ariëns;Arterioscler Thromb Vasc Biol,1999

5. Difficulties and pitfalls in the laboratory diagnosis of bleeding disorders;Bolton-Maggs;Haemophilia,2012

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