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OBSTETRIC ANESTHESIOLOGY

Factor XI Deficiency and Obstetrical Anesthesia

Amarjeet Singh, MBBS, DA, FRCA^*, Miriam J. Harnett, MB, FFARCSI^*, Jean M. Connors, MD, and William R. Camann, MD^*

From the *Division of Obstetric Anesthesiology, Department of Anesthesiology, Harvard Medical School, and Division of Hematology, Department of Medicine, Harvard Medical School, Brigham and Women’s Hospital, Boston, Massachusetts.

Address correspondence and reprint requests to Dr. William Camann, Department of Anesthesiology, Brigham and Women’s Hospital, 75 Francis St., Boston, MA 02115. Address e-mail to wcamann{at}partners.org.

Abstract

Factor XI (FXI) deficiency is a rare inherited coagulation disorder associated with prolonged activated partial thromboplastin time. The severity of bleeding often does not correlate with plasma factor levels. We reviewed the medical and anesthetic records of 13 parturients with FXI deficiency that presented for delivery. Nine cases were managed with neuraxial anesthesia. (epidural, seven; spinal, one; combined spinal-epidural, one). Three received general anesthesia for cesarean delivery, and one had an unmedicated vaginal delivery. Baseline factor levels ranged from severe (<15%) to mild (near 50%) deficiency. Fresh frozen plasma was administered to correct activated partial thromboplastin time in most, but not all, cases. Hematology consultation was obtained for all. No hematological or anesthetic complications were noted. FXI deficiency is not an absolute contraindication to neuraxial anesthesia, provided appropriate hematology consultation has been obtained, and factor replacement is provided as guided by clinical and laboratory hemostatic evaluation.