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Anaesthesia

Title:		Spinal anaesthesia and caesarean section in a patient with hypofibrinogenaemia and factor XIII deficiency
Author(s):		Hanke, A. A. Elsner, O. Gorlinger, K.
Address:		Department of Anaesthesiology and Intensive Care Medicine, Hannover Medical School, Germany. hanke.alexander@mh-hannover
Year:		2010 Jun
Journal Title:		Anaesthesia
Page Number:		641-5
Language:		eng
Volume:		65
Issue:		6
ISSN/ISBN:		1365-2044 (Electronic). 0003-2409 (Linking)
Abstract:		We report the peri-operative management of a 32-year-old patient suffering from symptomatic hypofibrinogenaemia and factor XIII deficiency scheduled for caesarean section. Starting with an impaired fibrinogen (1.04 g x l(-1)) and factor XIII level (48%), fibrinogen and factor XIII administration was guided by point-of-care rotational thrombelastometry (ROTEM) to achieve normal whole blood coagulation, which allowed uncomplicated spinal anaesthesia and an uneventful surgical procedure. We conclude that rotational thrombelastometry may be suitable to guide administration of coagulation factors in patients with hereditary bleeding disorders and allow otherwise contraindicated neuraxial anaesthesia and surgery to proceed without increased risk of blood loss.