Factor XI deficiency and its management.

Abstract

Factor XI deficiency has a more variable bleeding tendency than haemophilia A or B. Individuals with severe deficiency have only a mild bleeding tendency, which is typically provoked by surgery, but the risk of bleeding is not restricted to individuals with severe deficiency. The bleeding tendency varies between individuals with similar factor XI levels, and sometimes the bleeding tendency of an individual may vary. The reasons for this are not fully understood, although in cases of severe deficiency there is some correlation between phenotype and genotype. Factor XI is activated by thrombin. The role of factor XI in physiological processes has become clearer since this fact was discovered, and the discovery has contributed to a revised model of blood coagulation. Factor XI deficiency occurs in all racial groups, but is particularly common in Ashkenazi Jews. The factor XI gene is 23 kilobases long. Two mutations are responsible for most factor XI deficiency in the Ashkenazi population, but a number of other mutations have now been reported in other racial groups. Individuals with factor XI deficiency may need specific therapy for surgery, accidents, and dental extractions. Several therapies are available which include fresh frozen plasma, factor XI concentrates, fibrin glue, antifibrinolytic drugs, and desmopressin. Each has advantages and risks to be considered. Factor XI concentrate may be indicated for procedures with a significant risk of bleeding especially in younger patients with severe deficiency, but its use in older patients has been associated with thrombotic phenomena. If fresh frozen plasma is to be used it is preferable to obtain one of the virally inactivated products. Fibrin glue is a useful treatment which deserves further study.

• Authors: P H Bolton-Maggs
• Journal: Haemophilia : the official journal of the World Federation of Hemophilia (Haemophilia) Vol. 6 Suppl 1 Pg. 100-9 (Jul 2000) ISSN: 1351-8216 [Print] England
• PMID: 10982275 (Publication Type: Journal Article, Review)

Chemical References

• Factor XI

Topics

• Blood Coagulation
• Disease Management
• Factor XI (physiology, therapeutic use)
• Factor XI Deficiency (drug therapy, genetics)
• Humans
• Mutation
• Racial Groups (genetics)