The impact of acquired coagulation factor XIII deficiency in traumatic bleeding and wound healing
Christian Kleber,
Armin Sablotzki,
Sebastian Casu,
Martin Olivieri,
Kai-Martin Thoms,
Johannes Horter,
Felix C. F. Schmitt,
Ingvild Birschmann,
Dietmar Fries,
Marc Maegele,
Herbert Schöchl,
Michaela Wilhelmi
Affiliations
Christian Kleber
Medical Center, Orthopaedic, Trauma and Plastic Surgery Clinic, University of Leipzig
Armin Sablotzki
The Clinics of Anesthesiology, Critical Care and Pain Therapy, Klinikum St. Georg GmbH Leipzig
Sebastian Casu
Emergency Department, Asklepios Hospital Wandsbek
Martin Olivieri
Pediatric Thrombosis and Hemostasis Unit, Dr. Von Hauner Children’s Hospital, LMU Klinikum
Kai-Martin Thoms
Department of Dermatology, University Medical Center Goettingen
Johannes Horter
BG Klinik Ludwigshafen
Felix C. F. Schmitt
Department of Anaesthesiology, Heidelberg University Hospital
Ingvild Birschmann
Heart and Diabetes Center of Nordrhein-Westfalen, Institute of Laboratory and Transfusion Medicine, University Hospital of the Ruhr-University of Bochum
Dietmar Fries
Department of General and Surgical Intensive Care Medicine, Medical University Innsbruck
Marc Maegele
Department of Traumatology and Orthopedic Surgery, Cologne Merheim Medical Center (CMMC), Witten/Herdecke University
Herbert Schöchl
Department of Anaesthesiology and Intensive Care Medicine, AUVA Trauma Centre Salzburg, Academic Teaching Hospital of the Paracelsus Medical University
Abstract Factor XIII (FXIII) is a protein involved in blood clot stabilisation which also plays an important role in processes including trauma, wound healing, tissue repair, pregnancy, and even bone metabolism. Following surgery, low FXIII levels have been observed in patients with peri-operative blood loss and FXIII administration in those patients was associated with reduced blood transfusions. Furthermore, in patients with low FXIII levels, FXIII supplementation reduced the incidence of post-operative complications including disturbed wound healing. Increasing awareness of potentially low FXIII levels in specific patient populations could help identify patients with acquired FXIII deficiency; although opinions and protocols vary, a cut-off for FXIII activity of ~ 60–70% may be appropriate to diagnose acquired FXIII deficiency and guide supplementation. This narrative review discusses altered FXIII levels in trauma, surgery and wound healing, diagnostic approaches to detect FXIII deficiency and clinical guidance for the treatment of acquired FXIII deficiency.
