Perioperative course of FXIII in children undergoing major surgery

Summary Background:  Acquired deficiency of FXIII because of perioperative hemodilution has been described several times in adults; however, data in children are scarce. We performed a prospective observational trial to evaluate the intraoperative course of FXIII in children undergoing elective major surgery. Methods:  Blood samples were repeatedly taken from 46 children aged 0.3–16 years undergoing major surgery. Concentrations of FXIII and fibrinogen, thrombelastometry by ROTEM®, and cell count were assessed intraoperatively. Results:  A significant decrease in FXIII concentration (median 60%; IQR 49–69%) was already noted at beginning of surgical procedures, while most ROTEM® traces remain unchanged. FXIII levels further deteriorated intraoperatively to minimal levels of 33% (15–61%). Lowest intraoperative clot strength (ExTEM) was 44 mm (34–50 mm), and fibrinogen plasma levels decreased to minimal levels of 130 mg·dl−1 (95–160 mg·dl−1). In 43 of 46 children, transfusion therapy was necessary. Despite of transfusion of fresh frozen plasma (cumulative total dose 22 ml·kg−1 [11–32 ml·kg−1]) in 21 of 46 children, FXIII level remains low in all children till the end of surgery at levels of 39% (20–46%). Conclusions:  Coagulation factor XIII decreased early during major surgery owing to hemodilution. Overall intraoperative FXIII levels remain low despite of transfusion of fresh frozen plasma.