Management of Factor X Deficiency for Vaginal Delivery in a Parturient: A Case Report.

Factor X (FX) deficiency is a rare coagulopathy that may cause bleeding complications in parturients. The literature on rotational thromboelastometry (ROTEM; Instrumentation Laboratory, Bedford, MA) to guide factor repletion and neuraxial placement during partuition is limited. We present a 17-year-old parturient with FX deficiency after vaginal delivery with neuraxial anesthesia without bleeding complications. After FX concentrate administration, thromboelastometry was utilized to risk-stratify and manage her coagulopathy peripartum. Thromboelastometry may be a valuable adjunct to conventional monitoring in patient management. A limitation of this report is that coagulation tests and thromboelastometry were not assessed at identical timepoints.

Thromboelastometry-guided neuraxial anesthesia in a parturient with severe thrombocytopenia due to large granular lymphocytic leukemia.

Severe thrombocytopenia (platelet count <50 000/µl) in pregnancy is uncommon and is generally considered a contraindication to neuraxial anesthesia. We present a case of a parturient who presented with severe thrombocytopenia secondary to bone marrow failure. After receiving platelet and cryoprecipitate transfusions to correct coagulopathy as verified by thromboelastometry, neuraxial anesthesia was safely utilized.