[Thrombelastometric detection of factor XIII deficiency].

While undergoing Whipple's operation (pancreaticoduodenectomy) a patient developed diffuse bleeding and an unexpectedly high blood loss. An intraoperatively performed thrombelastometry with ROTEM (Pentapharm, Munich, Germany) showed an aprotonin-resistant mild fibrinolysis and suggested the presence of an isolated deficiency of coagulation factor XIII. This was confirmed by a second thrombelastometry, where no lysis was seen after in vitro substitution of factor XIII. After administration of 1250 IU factor XIII concentrate the diffuse bleeding ceased and further substitution of coagulation factor concentrates or fresh frozen plasma was not necessary. A postoperatively performed analysis confirmed the factor XIII deficiency (52%).