Sharief, LAT; (2013) Reproduction and Coagulation Factor XIII in Women. Doctoral thesis , UCL (University College London).

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Abstract

Factor XIII (FXIII) deficiency is a rare bleeding disorder associated with pregnancy loss and severe bleeding diathesis. However, there are limited data on the borderline level of FXIII that is needed to avoid obstetric complications. The aim of this study is to obtain a better understanding about the clinical course and outcome of FXIII deficiency among women. A systematic review of literature was performed for congenital FXIII deficiency among women and its associated reproductive outcomes using an electronic search on databases. A total of 116 women were identified from 34 articles. It was concluded that women with congenital FXIII deficiency suffer significant bleeding complications. Menorrhagia and ovulation bleeding are common gynaecological problems and possibly more prevalent than reported. A cross sectional study of 376 healthy pregnant women measured FXIII activity during first (weeks 0-12, n=116), second (weeks13-28, n=132) third trimester (weeks 29-42, n=128) and postnatal period (day0-3; n=30) and a control group (n=25). A significant reduction in FXIII activity during second and third trimester compared to first trimester of pregnancy (p<0.0001). Mean FXIII level during second and third trimester and postnatal period were significantly lower compared to control group. A second study involved 32 women aimed to examine changes in plasma FXIII activity during the normal menstrual cycle. FXIII level was significantly higher during periovulatory and secretory phases of the cycle compared to the menstrual phase (p=0.036). The third study evaluates FXIII level among 68 women with recurrent miscarriage, compared to 62 women with no history of pregnancy loss and at least one living child. Even though women with miscarriages had lower FXIII activity compare to control group, such difference did not reach a statistical significant level (p=0.142). However, women with history of miscarriage had significantly more cases with FXIII activity <70 IU/dL compared to control group (p=0.034). In conclusion, women with congenital FXIII deficiency suffer significant obstetrics and gynaecological complications. Pregnancy is associated with a significant decrease in FXIII activity, reaching the lowest level during the third trimester of pregnancy. FXIII activity was also found to be lowest during menstrual and preovulatory phase of the cycle. Women with history of recurrent miscarriage are more likely to have low FXIII (<70 IU/dL) levels.

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