Postoperative hemorrhagic complication due to acquired factor XIII deficiency: A case report

Patients with factor XIII (FXIII) deficiency exhibit bleeding tendency that is challenging to diagnose, wherein coagulation test results, such as prothrombin time and activated partial thromboplastin time, typically reveal normal findings. Herein, we report a 64-year-old man who presented to our hospital with FXIII deficiency. The patient had a medical history of asthma, Parkinson’s disease, hypertension, a large abdominal artery aneurysm, chronic kidney disease, and asymptomatic cerebral infarction. He was diagnosed with a left-sided mandibular dentigerous cyst. Dentigerous cystectomy and third molar extraction were performed without any significant complications. However, upon returning to the hospital room, the patient experienced persistent ongoing oozing from the surgical site. The bleeding persisted; FXIII deficiency was suspected. The diagnosis was confirmed on postoperative day ten. Following FXIII concentrate administration, the patient exhibited significant improvements in postoperative bleeding. FXIII deficiency should be considered in cases of severe oozing, even when coagulation testing reveals no major abnormal findings. Additionally, a disseminated intravascular coagulation score based on the Japanese criteria might be effective in evaluating the risk of postoperative bleeding, including FXIII deficiency.