“Familial Multiple Coagulation Factor Deficiencies of FXI and FXII in an Asymptomatic Saudi Woman”

Al-Ansari, Rehab Y.; Alruwaili, Atallah Fadel; Alqahtani, Khalid Mohammed; Al-Harbi, Amal Faed; Woodman, Alexander

Abstract

Factor XI deficiency (FXI) is the third most common coagulation factor deficiency after hemophilia A and B, ie, in the hierarchy after factors VIII and IX, taking into account von Willebrand’s factor deficiency, as bleeding disorders are higher than in hemophilia C. Factor XII deficiency (FXII) is a congenital condition, inherited in the vast majority of cases in an autosomal recessive manner, more often associated with thromboembolic complications. A combination of both factor deficiencies has been found very rarely, and it can be familial multiple coagulation factor deficiency (FMCFD). This study reports the case of a 39-year-old woman from Saudi Arabia who had the combination of FXI and FXII deficiencies, known to be on treatment for hypothyroidism and was referred to a hematology clinic with an incidental finding of prolonged activated partial thromboplastin time (aPTT). Although there was no history of bleeding tendency, her siblings had a family history of an unknown type of bleeding disorder. On physical examination, the patient did not show any bruising, petechiae, or ecchymosis. The aPTT was 69 seconds (27-38) with normal use of other hemostatic agents and was corrected after a 50:50 mixing study. Intrinsic coagulation factors were evaluated, and they revealed severe FXI and moderate FXII deficiencies. Due to a strong family history, the patient was diagnosed with FMCFD. In conclusion, familial combined multiple clotting factor deficiency (FCMFD) is a rare condition that requires attention and reporting. The management strategy in such cases has not been well studied, especially in the long-term symptomatic patient with severe but asymptomatic combined FXI and FXII deficiencies, which is an area for review and further study.

Citation

Al-Ansari, R. Y., Alruwaili, A. F., Alqahtani, K. M., Al-Harbi, A. F., & Woodman, A. (in press). “Familial Multiple Coagulation Factor Deficiencies of FXI and FXII in an Asymptomatic Saudi Woman”. Journal of Investigative Medicine High Impact Case Reports, 11, 23247096231199413. https://doi.org/10.1177/23247096231199413

• Journal Article Type: Article
• Acceptance Date: Aug 19, 2023
• Online Publication Date: Sep 13, 2023
• Deposit Date: Sep 18, 2023
• Publicly Available Date: Sep 18, 2023
• Journal: Journal of Investigative Medicine High Impact Case Reports
• Print ISSN: 2324-7096
• Publisher: SAGE Publications
• Peer Reviewed: Peer Reviewed
• Volume: 11
• Pages: 23247096231199413
• DOI: https://doi.org/10.1177/23247096231199413
• Keywords: factor deficiency, bleeding, factor XI, factor XII, coagulation