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Hajjar R, Hatoum I, Krounbi A, Chahine R, Jalloul R, Ramadan MK. Pregnancy in a woman with congenital F-VII deficiency: a brief review of recent literature and case report. Hematol Transfus Cell Ther 2023; 45:394-398. [PMID: 34565715 PMCID: PMC10499559 DOI: 10.1016/j.htct.2021.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 07/10/2021] [Indexed: 11/29/2022] Open
Affiliation(s)
- Rima Hajjar
- American University in Beirut-Medical Center, Department of Obstetrics and Gynecology, Beirut, Lebanon
| | - Inaam Hatoum
- Rafik Hariri University Hospital, Beirut, Lebanon
| | | | - Rabih Chahine
- American University in Beirut-Medical Center, Department of Obstetrics and Gynecology, Beirut, Lebanon; Rafik Hariri University Hospital, Beirut, Lebanon
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Krzyżanowski A, Gęca T, Sokołowska B, Kwiatek M, Miturski A, Stupak A, Terlecki P, Paluszkiewicz P, Kwaśniewska A. Thromboelastometry as an Ancillary Tool for Evaluation of Coagulation Status after rFVIIa Therapy in a Pregnant Woman with Severe Hypoproconvertinemia-A Case Series and Review of the Literature. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10918. [PMID: 36078653 PMCID: PMC9518547 DOI: 10.3390/ijerph191710918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Revised: 08/20/2022] [Accepted: 08/30/2022] [Indexed: 06/15/2023]
Abstract
Introduction: Factor VII (FVII) deficiency is a rare hemorrhagic diathesis. In females, heavy menstrual and postpartum bleeding can appear as a consequence of its deficiency. Supplementation of the recombinant FVIIa is widely accepted. The supplementation effect in FVII-deficient subjects is difficult to predict, and severe hemorrhage has been described even when FVII levels after supplementation were within normal ranges. The aim of this report is to present the application of thromboelastometry to control the coagulation status in a patient with severe FVII deficiency during pregnancy and delivery, supplemented by rFVIIa per protocol complicated with life-threatening venous thromboembolism. Methods: Rotational thromboelastometry (ROTEM) was performed in 16 pregnant women: in one 28 year old primigravida at 35 weeks of pregnancy with congenital FVII deficiency after rFVIIa administration and 15 healthy women at 38 gestational weeks. The results were compared. Results: The thromboelastometry results showed significant shortening of the clotting time in the extrinsic and the intrinsic pathway in the hypoproconvertinemia patient after rFVIIa administration in relation to healthy pregnant women. A significant reduction in maximum lysis of the clot after FVII supplementation was observed. Conclusions: The thromboelastometry results showed a significant hypercoagulable state with hypoproconvertinemia. Thrombotic complications after delivery might be prevented by the reduction in rFVIIa guided by thromboelastometry. Thromboelastometry performed on a pregnant woman with factor VII deficiency during the supplementation of rFVIIa in peripartum time might be helpful in order to determine an individual, effective dosage regimen of rFVIIa to ensure full correction of clotting disorders without the tendency to develop thrombosis, but further studies are needed.
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Affiliation(s)
- Arkadiusz Krzyżanowski
- Chair and Department of Obstetrics and Pathology of Pregnancy, Medical University of Lublin, 20-081 Lublin, Poland
| | - Tomasz Gęca
- Chair and Department of Obstetrics and Pathology of Pregnancy, Medical University of Lublin, 20-081 Lublin, Poland
| | - Bożena Sokołowska
- Chair and Department of Haematooncology and Bone Marrow Transplantation, Medical University of Lublin, 20-059 Lublin, Poland
| | - Maciej Kwiatek
- Chair and Department of Obstetrics and Pathology of Pregnancy, Medical University of Lublin, 20-081 Lublin, Poland
| | - Andrzej Miturski
- Chair and Department of Obstetrics and Pathology of Pregnancy, Medical University of Lublin, 20-081 Lublin, Poland
| | - Aleksandra Stupak
- Chair and Department of Obstetrics and Pathology of Pregnancy, Medical University of Lublin, 20-081 Lublin, Poland
| | - Piotr Terlecki
- Chair and Department of Vascular Surgery and Angiology, Medical University of Lublin, 20-081 Lublin, Poland
| | - Piotr Paluszkiewicz
- Department of General, Oncological and Metabolic Surgery, Institute of Haematology and Transfusion Medicine, 14 I. Gandhi Str., 02-776 Warsaw, Poland
| | - Anna Kwaśniewska
- Chair and Department of Obstetrics and Pathology of Pregnancy, Medical University of Lublin, 20-081 Lublin, Poland
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Yang Y, Zeng YC, Rumende P, Wang CG, Chen Y. Diagnosis and treatment discussion of congenital factor VII deficiency in pregnancy: A case report. World J Clin Cases 2021; 9:6091-6101. [PMID: 34368331 PMCID: PMC8316952 DOI: 10.12998/wjcc.v9.i21.6091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 05/09/2021] [Accepted: 05/26/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Congenital factor VII deficiency (FVIID) is a rare autosomal recessive genetic disorder. The clinical manifestations of this deficiency vary greatly. Predicting the risk of bleeding during and after childbirth of pregnant women with congenital FVIID is difficult. Recombinant factor VIIa is the most common replacement therapy for FVIID. However, no unified diagnosis and treatment plan for pregnant women with congenital FVIID has been established.
CASE SUMMARY We report the clinical history of a pregnant woman who was considered to have congenital FVIID. Recombinant factor VIIa was prophylactically administered to the pregnant woman at the time of cervical fully opening. She successfully delivered a live infant without any complications, such as postpartum hemorrhage, neonatal abnormalities, and so on.
CONCLUSION Prophylaxis of recombinant factor VIIa during delivery can effectively reduce the incidence of postpartum hemorrhage among pregnant women with congenital FVIID associated with a high risk of bleeding.
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Affiliation(s)
- Ying Yang
- Department of Obstetrics, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Ya-Chang Zeng
- Department of Obstetrics, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Pingkan Rumende
- Department of Obstetrics, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Chen-Guang Wang
- Department of Obstetrics, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Yue Chen
- Department of Obstetrics, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
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Elkhateb IT, Mousa A, Mohye Eldeen R, Soliman Y. Accidentally discovered high INR in pregnancy unmasks an inherited factor VII (FVII) deficiency that is paradoxically associated with thrombotic tendency. BMJ Case Rep 2021; 14:14/2/e237781. [PMID: 33542014 PMCID: PMC7868182 DOI: 10.1136/bcr-2020-237781] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
A 32-year-old multiparous obese woman was referred to our center at 37 weeks of twin gestation. She was referred for birth planning following an accidentally discovered high international normalised ratio (INR) in routine preoperative labs. Her history was significant for recurrent pregnancy-associated deep venous thrombosis as well as two early pregnancy losses. Further work-up revealed transaminitis, mild splenomegaly and high lupus anticoagulant titre. A multidisciplinary team of physicians from the high-risk pregnancy, anaesthesiology, haematology, gastroenterology and hepatology departments put a management plan; it culminated into uncomplicated delivery of the patient by repeated caesarian section. The team was also able to figure out the cause of the patient's high INR that is associated with thrombophilia rather than haemophilia.
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Affiliation(s)
| | - Abdalla Mousa
- Obstetrics and Gynecology Department, Cairo University Kasr Alainy Faculty of Medicine, Cairo, Egypt
| | - Riham Mohye Eldeen
- Dermatology Department, Cairo University Kasr Alainy Faculty of Medicine, Cairo, Egypt
| | - Yssra Soliman
- Dermatology Department, Albert Einstein College of Medicine, Bronx, New York, USA
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Management of Labour and Delivery in a Patient With Acquired Factor VII Deficiency With Inhibitor: A Case Report. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2016; 38:160-3. [PMID: 27032741 DOI: 10.1016/j.jogc.2015.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 10/02/2015] [Indexed: 12/16/2022]
Abstract
BACKGROUND Acquired factor VII (FVII) deficiency with inhibitor increases the risk of hemorrhage during pregnancy. However, there are no published reports guiding its management in the peripartum period. CASE A 24-year-old woman with inhibitory antibodies to FVII delivered at 34 weeks of gestation. The patient was administered recombinant factor VIIa (rFVIIa) and tranexamic acid. There were no bleeding-related complications; however, the FVII level was supratherapeutic. The patient returned during a second pregnancy. A reduced dose of rFVIIa was administered. The delivery was complicated by postpartum hemorrhage, which resolved with the addition of uterotonic agents. CONCLUSION Recombinant FVIIa and tranexamic acid offer an effective peripartum treatment in women with inhibitory antibody to FVII. Further research should delineate the optimal time of administration.
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Chen P, Sinha A. Anaesthetic management of a parturient with factor VII deficiency and sepsis. Int J Obstet Anesth 2015; 24:395-7. [PMID: 26303752 DOI: 10.1016/j.ijoa.2015.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Revised: 06/05/2015] [Accepted: 06/07/2015] [Indexed: 10/23/2022]
Affiliation(s)
- P Chen
- Anaesthetic Department, West Suffolk Hospital, Suffolk, UK.
| | - A Sinha
- Anaesthetic Department, West Suffolk Hospital, Suffolk, UK
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Baumann Kreuziger LM, Morton CT, Reding MT. Is prophylaxis required for delivery in women with factor VII deficiency? Haemophilia 2013; 19:827-32. [PMID: 23607277 PMCID: PMC3769463 DOI: 10.1111/hae.12167] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2013] [Indexed: 12/11/2022]
Abstract
Factor VII (fVII) deficiency is a rare congenital bleeding disorder in which fVII activity level and bleeding tendency do not completely correlate. Pregnancy and delivery present a significant haemostatic challenge to women with fVII deficiency. Treatment with recombinant factor VIIa (rfVIIa) carries a thrombotic risk and the literature is not clear whether prophylaxis is necessary prior to delivery. The aim of this study was to define management, haemorrhagic and thrombotic complications of pregnant women with fVII deficiency through a systematic review. Medical databases (PubMed, MEDLINE, CINAHL, Academic Search Premier, Cochrane Library, Web of Science and Scopus) were searched using "factor VII deficiency" and "pregnancy" or "surgery." Overall 34 articles, four abstracts, and three institutional cases were reviewed. Literature from 1953 to 2011 reported 94 live births from 62 women with fVII deficiency. The median fVII activity was 5.5%. Haemostatic prophylaxis was used in 32% of deliveries. Without prophylaxis, 40 vaginal deliveries and 16 caesarean sections were completed. The odds of receiving prophylaxis were 2.9 times higher in women undergoing caesarean section compared to vaginal delivery. Post-partum haemorrhage occurred in 10% of deliveries with prophylaxis and 13% of deliveries without prophylaxis. The fVII level did not significantly differ between women who did and did not receive prophylaxis. We present the only systematic review of the management of pregnancy in fVII deficient women. No difference in post-partum haemorrhage was seen in deliveries with and without prophylaxis. Therefore, we recommend that rfVIIa be available in the case of haemorrhage or surgical intervention, but not as mandatory prophylaxis.
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Affiliation(s)
- Lisa M. Baumann Kreuziger
- University of Minnesota, Division of Hematology, Oncology, and Transplantation, Mayo Mail Code 480, 420 Delaware St. S.E., Minneapolis, MN, USA 55455
| | - Colleen T. Morton
- Regions Hospital, Department of Hematology and Oncology, 640 Jackson Street, St. Paul, MN 55101
| | - Mark T. Reding
- University of Minnesota, Division of Hematology, Oncology, and Transplantation, Mayo Mail Code 480, 420 Delaware St. S.E., Minneapolis, MN, USA 55455
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