Factor XIII and surgical bleeding

Factor XIII (FXIII) is the final factor in the coagulation cascade. It converts soluble fibrin monomers into a stable fibrin clot, prevents premature degradation of fibrin, participates in wound healing, and helps prevent the loss of the endothelial barrier function. FXIII deficiency is believed to be rare, and this may explain why clinicians do not routinely take it into consideration. Congenital FXIII deficiency is a rare disease with a reported prevalence of 1 per million. However, the prevalence of acquired FXIII deficiency is much higher. Acquired forms have been described in patients with decreased hepatic or bone marrow synthesis, overconsumption and increased degradation by autoantibodies. This review offers guidance on how to suspect and diagnose FXIII deficiency in both the preoperative consultation and different surgical settings. We also analyze current scientific evidence in order to clarify when and why this clinical situation should be suspected, and how it may be treated. (Cite this article as: Guilabert P, Asmis L, Cortina V, Barret JP, Colomina MJ. Factor XIII and surgical bleeding. Minerva Anestesiol 2022;88:156-65. DOI: 10.23736/S0375-9393.22.15772-X)

Automated summary

Factor XIII (FXIII) is the final factor in the coagulation cascade and its deficiency can lead to surgical bleeding. Congenital FXIII deficiency is rare, while acquired FXIII deficiency is more common. This review provides guidance on the diagnosis and treatment of FXIII deficiency in preoperative consultation and surgical settings.