Pediatric severe factor XI deficiency: A multicenter study

• Published in: Pediatric blood & cancer 2022-03, Vol.69 (3), p.e29545-n/a
• Main Authors: Barg, Assaf Arie, Levy‐Mendelovich, Sarina, Budnik, Ivan, Mandel‐Shorer, Noa, Dardik, Rima, Avishai, Einat, Brutman‐Barazani, Tami, Ifrah, Aviya Dvir, Oren‐Malek, Liat, Yacobovich, Joanne, Gilad, Oded, Nakav, Sigal, Fruchtman, Yariv, Revel‐Vilk, Shoshana, Miskin, Hagit, Kenet, Gili
• Format: Article
• Language: English
• Subjects: Adult; Bleeding; Child; Children; Coagulation factors; Cohort Studies; Data collection; Diagnosis; Factor XI - therapeutic use; Factor XI deficiency; Factor XI Deficiency - complications; Factor XI Deficiency - therapy; Female; Hematology; Hemorrhage; Hemorrhage - complications; Hemorrhagic Disorders; Hemostasis; Hemostatics - therapeutic use; Hereditary diseases; Humans; Infant, Newborn; Intracranial Hemorrhages; Neonates; Oncology; pediatric; Pediatrics; Pregnancy; thrombosis; Trauma; treatment
• ISSN: 1545-5009; 1545-5017
• DOI: 10.1002/pbc.29545

Background Factor XI (FXI) deficiency is a rare autosomal recessive bleeding disorder. Only scarce publications address its clinical features in children. The increased prevalence of FXI deficiency in Israel enabled data collection for this large multicenter cohort study. Objective Some hemostatic challenges may be unique or more common in children, such as bleeding in the neonatal period or trauma‐related injury. The current study was designed to explore the potential impact of these differences in children with severe FXI deficiency. Methods Medical files of all children with FXI level under 15% followed at five tertiary centers were evaluated. The retrieved data comprised demographic and clinical characteristics, including bleeding episodes, surgical interventions, treatment strategies, as well as laboratory features. Results Sixty children, whose median age at diagnosis was 4.2 years and their median FXI level was 4%, were included. Three children experienced triggered intracranial hemorrhage (ICH) and two children had major bleeds. No bleeding complications occurred in surgeries in which hemostatic treatment consisting mostly of tranexamic acid or fresh frozen plasma was applied (n = 45). In contrast, excessive bleeding was noted in 25% of surgical procedures performed without hemostatic preparation (p = .002). Conclusion This study's findings confirm the generally favorable outcome of this rare bleeding disorder, with no spontaneous bleeds or cases of perinatal ICH. Nonetheless, proper diagnosis and adequate hemostasis in the surgical setting are imperative. Unlike previous studies in adults, our pediatric study suggests an association between the severity of FXI deficiency and bleeding tendency.