• Aryeh Shander, Tamara Friedman, Greg Palleschi, and Linda Shore-Lesserson.
• From the Department of Anesthesiology, Critical Care Medicine, Pain Management, and Hyperbaric Medicine, Englewood Hospital and Medical Center, Englewood, New Jersey.
• Anesth. Analg. 2018 Jun 1; 126 (6): 2032-2037.

AbstractA case of a patient with severe factor XI (FXI) deficiency who presented for her seventh labor and delivery is presented. The nature of FXI deficiency, its prevalence, and issues related to genetic screening are discussed. Published literature on the topic is reviewed, including criteria that were developed to assess bleeding, laboratory tools used to estimate bleeding risk, and available treatments. Within the context of this challenging clinical dilemma, specific recommendations are provided for the antepartum, intrapartum, and postpartum stages of pregnancy. These include recommendations that take into account both FXI levels and history of any abnormal bleeding. While there are effective treatments available, it is important to consider that institutional multidisciplinary protocols are needed to manage this complex disorder. More work is needed to define the best management protocols.

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