Abnormal bleeding after lumbar vertebrae surgery because of acquired factor XIII deficiency: A case report and literature review

Medicine (Baltimore). 2024 Jan 12;103(2):e36944. doi: 10.1097/MD.0000000000036944.


Rationale: Abnormal bleeding due to low fibrinogen (Fib) and coagulation factor XIII (FXIII) levels after lumbar vertebral surgery is exceedingly rare. Excessive bleeding is also associated with secondary hyperfibrinolysis. This report presents a case of abnormal incision bleeding caused by coagulation factor XIII deficiency (FXIIID) and secondary hyperfibrinolysis in a state of low fibrinogen after lumbar vertebral surgery.

Patient concerns: A middle-aged woman experienced prolonged incision and excessive bleeding after lumbar vertebral surgery.

Diagnosis: Combined with coagulation factors, coagulation function tests, and thromboelastography, the patient clinical presentation supported the diagnosis of FXIIID and secondary hyperfibrinolysis in a hypofibrinogenemic state.

Interventions: Cryoprecipitat, Fresh Frozen Plasma, Fibrinogen Concentrate, Leukocyte-depleted Red Blood Cells, Hemostatic (Carbazochrome Sodium Sulfonate; Hemocoagulase Bothrops Atrox for Injection; Tranexamic Acid).

Outcomes: After approximately a month of replacement therapy and symptom treatment, the patient coagulation function significantly improved, and the incision healed without any hemorrhage during follow-up.

Lessons: Abnormal postoperative bleeding may indicate coagulation and fibrinolysis disorders that require a full set of coagulation tests, particularly coagulation factors. Given the current lack of a comprehensive approach to detect coagulation and fibrinolysis functions, a more comprehensive understanding of hematology is imperative. The current treatment for FXIIID involves replacement therapy, which requires supplementation with both Fib and FXIII to achieve effective hemostasis.

Publication types

  • Review
  • Case Reports

MeSH terms

  • Blood Coagulation Factors
  • Factor XIII / therapeutic use
  • Factor XIII Deficiency* / complications
  • Female
  • Fibrinogen
  • Humans
  • Lumbar Vertebrae / surgery
  • Middle Aged
  • Postoperative Hemorrhage / etiology
  • Postoperative Hemorrhage / therapy


  • Factor XIII
  • Blood Coagulation Factors
  • Fibrinogen