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Delayed Hemorrhage After Cervical Conization Unmasking Severe Factor XI Deficiency

Sarah H. Kim, MD^*, Sindhu K. Srinivas, MD^*, Stephen C. Rubin, MD^*, Louis J. Freedman, MD and Heidi J. Gray, MD^*

*Department of Obstetrics and Gynecology, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania; and Wilkes-Barre, Pennsylvania

Address reprint requests to: Heidi J. Gray, MD, University of Pennsylvania, Department of Obstetrics and Gynecology, 3400 Spruce Street, Philadelphia, PA, 19104; e-mail: hgray{at}mail.obgyn.upenn.edu.

BACKGROUND: Factor XI deficiency, a rare bleeding disorder found most commonly in patients of Ashkenazi Jewish background, may be present in patients with a history of abnormal bleeding after elective surgery.

CASE: A patient of Ashkenazi Jewish descent presented 12 days after cervical conization for adenocarcinoma in situ with severe vaginal bleeding requiring multiple transfusions and uterine artery embolization. After a thorough workup, a severe factor XI deficiency was found. The patient ultimately required modified radical hysterectomy for treatment of early cervical cancer. With appropriate perioperative management, the patient underwent abdominal surgery without further bleeding complications.

CONCLUSION: Factor XI deficiency can present with severe bleeding episodes after elective surgery. Adequate preoperative assessment and perioperative management are necessary to prevent bleeding complications in these patients.