Researchers from the Queen’s Medical Centre in Nottingham, United Kingdom (UK) recently reported that women with symptomatic factor XI (FXI) deficiency are susceptible to postpartum bleeding. FXI deficiency, also called hemophilia C or Rosenthal syndrome, is a rare bleeding disorder with an estimated worldwide incidence of 1 in 100,000 people. The disorder is more common among Ashkenazi Jews of Eastern European descent.
While spontaneous bleeds into joints, muscles or soft tissues--seen more often in people with moderate to severe hemophilia A and B--are uncommon in FXI patients, event-triggered bleeding does occur. Surgery, trauma, dental work and menstruation are examples of conditions in which FXI patients may experience excessive bleeding. After reviewing the medical files of 33 women with FXI deficiency, UK investigators compiled data suggesting that postpartum hemorrhage be included as a common symptom of this rare disorder.
Bleeding manifestations in people with FXI deficiency can vary widely from person to person, with some patients never experiencing symptoms. For that reason, investigators grouped the 33 women into two categories based on their case files: 16 as "bleeders" and 17 as "non-bleeders." In all, these women went through 105 pregnancies. An analysis of clinical data showed that 71% of the women experienced a pregnancy and delivery with no additional complications. Live births took place in 76% of the nonbleeders and 65% of the bleeders. No appreciable difference in the incidence of miscarriage was reported between the groups.
Most notably, bleeders demonstrated a likelihood of postpartum hemorrhage that was seven times higher than that of nonbleeders. While acknowledging that an additional study is necessary to further clarify the criteria used to identify “bleeders” among FXI patients, the investigators felt enough evidence of increased risk exists to justify careful scrutiny and precaution in this subpopulation during childbirth and the post-partum period.
The study, "Pregnancy Outcome in Factor XI Deficiency: Incidence of Miscarriage, Antenatal and Postnatal Haemorrhage in 33 Women with Factor XI Deficiency," was published in the May 2007 issue of the British Journal of Obstetrics and Gynaecology.
Source: Reuters Health, May 25, 2007