Postoperative haemorrhage in a patient with factor XIII deficiency: diagnostic and therapy

We report a case of a 57-year-old patient with stomach cancer. The patient underwent an elective 4/5 gastrectomy. The haemodynamically stable and spontaneously breathing patient was monitored in the post anaesthesia care unit for 13 hours. The next day he was discharged to a surgical ward. Three days later, abdominal bleeding through a passive abdominal drain tube occurred, and the patient was admitted to the intermediate care unit. Because of clinical relevant anaemia the patient required transfusion of red blood cell concentrates. Conventional coagulation testing showed that values were within normal reference ranges. Testing individual clotting factors revealed a decreased factor XIII activity as a potential underlying cause of the persistent bleeding. In this case report, we describe and discuss our diagnostic and therapeutic management.