A Sardinian Family with Factor XI Deficiency

Doris Barcellona; Giovanni Favuzzi; Maria Luigia Vannini; Sebastiana Maria Piras; Maria Filomena Ruberto; Elvira Grandone; Francesco Marongiu

doi:10.1055/s-0039-1691752

Hämostaseologie, Table of Contents

Hamostaseologie 2019; 39(04): 398-403
DOI: 10.1055/s-0039-1691752

Case Report

Georg Thieme Verlag KG Stuttgart · New York

A Sardinian Family with Factor XI Deficiency

Authors

Doris Barcellona

¹Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy
Giovanni Favuzzi

²Atherosclerosis and Thrombosis Unit, IRCCS Ospedale Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy
Maria Luigia Vannini

¹Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy
Sebastiana Maria Piras

¹Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy
Maria Filomena Ruberto

¹Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy
Elvira Grandone

²Atherosclerosis and Thrombosis Unit, IRCCS Ospedale Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy

³Department of Obstetrics and Gynecology, I.M. Sechenov First Moscow State Medical University, Moskva, Russia
Francesco Marongiu

¹Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy

Abstract

Introduction Factor XI (FXI) deficiency is a bleeding disorder which causes a bleeding tendency after trauma or surgery. An inhibitor may be acquired secondary to replacement therapy.

Aim To study on genetical and functional grounds a family admitted to our Haemostasis and Thrombosis Centre for an incidental finding of a prolonged activated partial thromboplastin time (aPTT) in three members.

Methods aPTT mixing test, dosage of FXI activity and antigen, FXI inhibitor titration, DNA analysis and clot waveform analysis (CWA) were performed.

Results Patients II.1, II.3 and II.4 showed a severe FXI deficiency (0.7, 0.7 and 1.8%, respectively) and low antigen level. Since the proposita was already treated with plasma, the dosage of the inhibitor was determined to be 6.4 Bethesda units. They were homozygous for the p.Glu117Stop mutation. The other family members were heterozygous. The velocity and the maximum acceleration of the clot formation were lower than those of the other family members and the normal subjects but higher than those of patients with acquired haemophilia A.

Conclusion A mixing test of a prolonged aPTT should be performed because it will be present both in patients with or without the inhibitor. A molecular analysis in severe FXI deficiency is warranted as it may have prognostic significance. CWA may be helpful for better understanding the pathophysiology of this kind of defect.

Keywords

factor XI deficiency - FXI inhibitor - bleeding - clot waveform analysis - aPTT

Full Text

References

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