手術中の予期せぬ出血傾向に第XIII因子活性低下の影響が疑われた1症例

Unexpected Bleeding Disorder during Abdominal Surgery, Suspected of Being Associated with Decreased Factor XIII Activity

要旨

　一般的な凝固検査値に異常を認めなくても，出血傾向を認めるまれな病態に第XIII因子活性低下がある。術前凝固検査が正常の70歳代女性における開腹手術中に出血傾向を認め，術後に第XIII因子活性低下を指摘した症例を経験した。検査値の異常を伴わない出血傾向を認めたときは第XIII因子活性低下も疑うべきである。

　Decreased factor XIII activity is a rare condition that can cause a bleeding disorder without abnormalities in the platelet count, prothrombin time（PT）, or activated partial thromboplastin time（APTT）. A Japanese woman in her 70s with no history of bleeding underwent an abdominal hysterectomy, during which the amount of blood loss was 1171 mL. A bleeding disorder was suspected, but the patient’s platelet count, PT, and APTT values were all within the normal range, and the factor XIII activity was 48％. In light of this patient’s case, it is apparent that when a suspected bleeding disorder is observed without abnormal platelet, PT, or APTT values, the patient’s factor XIII activity should be examined.