SEARCH · Search PubMed
Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
A 38-years-old woman is presented with recurrent postoperative bleedings. The coagulation analysis revealed a factor XIII deficiency. The treatment consisted in transfusions of factor XIII concentrates.
Clinical and hematological data of 9 cases with factor XIII deficiency is highlighted. The age at first bleed ranged from 3 days of life to 1 year. Seven of these 9 cases had bleeding from the umbilicus, 3 had recurrent subcutaneous and muscle hematomas, while 4 cases had CNS bleeds of which 3 expired. Routine coagulogram was normal, while clot solubility in 5 molar urea solution was abnormal in all cases. Factor XIII assay was not done in any. Patients were treated with plasma transfusion during episodes of bleeding. No patient received plasma transfusion as prophylactic therapy. The cumulative Indian data so far documented, inclusive of this series, shows a very high incidence of CNS bleeds (33%) in patients with this inherited coagulation disorder.
In previously reported cases, congenital deficiency of coagulation factor XIII has been found to result from the absence of the enzymatically active A subunits. In the family reported here two members were found to be heterozygous for an unstable A subunit which, in the homozygous state, or in the heterozygous state with the previously described null allele, would be expected to result in factor XIII deficiency. The implications that this new variant has on heterozygote screening are discussed.
The use of a pasteurization step (heating in solution to 60 degrees C for 10 h) makes it possible to inactivate viruses, thus increasing the safety of the preparations. Using Factor XIII concentrate solution, it can be shown that hepatitis B virus and 10 other virus species are inactivated. Pasteurized Factor XIII was produced from starting material containing a total of 10(5.7) CID50 hepatitis-B virus (10(3.5) CID50/ml; CID = chimpanzee infectious dose). This Factor XIII preparation was injected in 4 chimpanzees; they remained healthy over an observation period of 37 weeks, whereas the 2 chimpanzees that received nonheated starting material developed hepatitis B. Furthermore, Rous-sarcoma, Epstein-Barr, cytomegalo, herpes simplex, measles, and rubella virus added to Factor XIII solution are inactivated by pasteurization within 2 h, mumps virus within 8 h, and adeno, polio, and vaccinia virus within 10 h. Pasteurizing of clotting factor preparations during the manufacturing process is a suitable for inactivating viruses and thereby increasing the safety of the preparations.
In the present study, parameters of the fibrinolytic system and factor XIII were determined in 26 women with spontaneous abortion and in 21 women with intact pregnancies to gain insight into the role of fibrinolysis in spontaneous abortion. Both groups of women did not significantly differ from each other in age or weeks of pregnancy. There were no differences in euglobulin lysis time (ELT), tissue plasminogen activator (t-PA) antigen, and plasminogen activator inhibitor type 1 (PAI-1) antigen between the study group and the control group. Factor XIII activity was significantly decreased in patients during abortion. In the present study, changes of fibrinolytic parameters measured in teh cubital vein blood of patients with abortion were not observed although local changes in fibrinolytic activity had been associated with spontaneous abortion. The pathophysiological role of the decrease in factor XIII activity observed in the present study remains to be elucidated.
Bleeding is a common complication in patients suffering from multiple myeloma. In some cases a defect in fibrin formation has been suggested as one possible cause of haemorrhagic tendency. As shown in this investigation the defect in fibrin formation, ascertained using PAGE, is due to a lack of alpha-chain polymerization of fibrin monomers in 5/11 patients with IgG myeloma and in 2/5 patients with IgM paraproteinaemia. No disturbed fibrin polymerization could be observed in IgA myeloma (n = 6). Factor XIII concentrations of subunit A and to a lesser extent of subunit S (Laurell technique) were highly elevated in all cases with regular fibrin formation. comparable values were obtained by measuring the transamidase activity of factor XIII by incorporation of 14C-labelled purtrescin into casein. Levels up to 600% of normal could be recorded. In contrast, all patients with a lack of alpha-chain polymerization had a factor XIII activity within the normal range. Addition of factor XIII concentrate to plasma from patients with defective fibrin formation led in 5/8 cases to a partial cross-linking of alpha-monomers. we conclude that in some cases paraproteins can inhibit the factor XIII and prevent its action on fibrin.
Based on the description of a severe bleeding disorder in a young child a short overview on the genetics, the epidemiology, the pathophysiology, the clinical manifestations and the laboratory diagnosis of factor XIII deficiency is presented. The impressive clinical signs with bleeding starting in the neonatal period (prolonged bleeding from the umbilical cord), followed by severe, life-threatening episodes of intracranial hemorrhages should raise the clinical suspicion of FXIII deficiency. Difficulty of laboratory diagnosis is stressed. The importance of repeating initially negative screening tests and of performing a quantitative FXIII assay in the presence of strong clinical suspicion is strengthened. The diagnosis of factor XIII deficiency is difficult but has important therapeutic consequences: patients with documented severe deficiency should be put on regular substitution with factor XIII concentrates. Appropriately timed periodic infusions of such factor XIII concentrates enable patients to live normal lives, free from catastrophic bleeding episodes.
We report an infant with Factor XIII deficiency who had 2 seemingly spontaneous intracranial hemorrhages. It is important to consider Factor XIII deficiency as a possible cause of unexplained intracranial hemorrhages in infancy. Ongoing factor replacement therapy is recommended to prevent further bleeding episodes.
In 16 patients affected with acute leukemia (7 patients with acute lymphatic leukemia and 9 patients with acute myeloid leukemia) the resonance thrombogramme was recorded during cytostatic induction therapy, coagulation factor XIII (subunit XIII-A, XIII-S) and further hemostasiological parameters were determined. Subunit XIII-A was lowered to 36%, subunit XIII-S to 65% and the fibrin formation time of the resonance thrombogramme was extended to 9 minutes. There exists a negative correlation between component XIII-A and fibrin formation time r = -0.48 (p less than 0.01). The influence exerted by diminishing factor XIII and fibrin(ogen) splitting products on the fibrin formation time was investigated in in-vitro tests. A diminution of factor XIII below 10% will extend the fibrin formation time to about 10 minutes, an increase of fibrin(ogen) splitting products to 100 micrograms/ml to about 3 minutes.
Factor XIII deficiency is a rare autosomal (1:2,000,000) recessive disorder of blood coagulation usually attributed to mutations in the coagulation factor XIII (FXIII) A gene. We have studied the molecular basis of FXIII deficiency in eight unrelated South Indian patients. Their diagnosis was based on clinical history, normal plasma clotting times and increased solubility of fibrin clot in 5 mol/l urea. Genomic DNA was screened for FXIII A gene defects by a novel PCR and CSGE strategy. Mutations were identified in all these patients. Five of these were novel mutations occurring in four patients. These included a novel c.210T > G transversion in homozygosity in exon 3 predicting a Tyr69X in the beta-sandwich domain in one patient. Another patient was compound heterozygote for a novel c.791C > T transition predicting a Ser263Phe in the core domain and a novel c.2045-1G > A transition at the acceptor splice junction of intron 14. Two novel frame shifts were also identified in two patients in a homozygous condition. One of them resulted from a single base 'G' duplication (c.892_895dupG) at codons Ser290/Ala291fs affecting the core domain and the other was due to a single base 'A' duplication (c.1642_1644dupA) and at codonTyr547fs affecting barrel-1 domain. The remaining four patients had the previously reported Arg260His, Ser413Leu, and Val414Phe (n = 2) missense mutations in the core domain. The novel mutations identified were considered to be disease causative by studying the nature of mutation, the degree of conservation of the mutated aminoacid among transglutaminases of different species and by molecular modeling. Apart from describing a significant number of novel mutations, this report is the first study from Southern India to describe FXIII A gene mutations.
When compared to age-matched normal weight normolipidemic control subjects, plasma factor XIII, plasma fibronectin and serum cholinesterase levels were found to be markedly decreased in patients with decompensated cirrhosis of the liver, not significantly changed in hyperlipoproteinemia type IIa (heterozygous subjects) and increased in hypertriglyceridemic subjects (type IIb and IV) as well as in hyperlipidemic nephrotic patients. A possible accelerated hepatic synthesis of certain plasma proteins including factor XIII and fibronectin in patients with the nephrotic syndrome as well as in endogenous hypertriglyceridemia is envisaged. It is also considered that mural thrombi, richer in factor XIII and fibronectin, would be more resistant to fibrinolysis and more readily attached to subendothelial structures.
Minor labial salivary glands obtained at biopsy from patients with Sjögren's syndrome were investigated by immunomorphological methods for the presence of monocyte-derived macrophages. According to our observations published earlier the immunomorphological detection of factor XIII subunit a is a useful marker for recognizing cells of monocyte/macrophage lineage. Factor XIII subunit a was detected by a highly sensitive immunoperoxidase staining, and cells containing this coagulation enzyme were characterized by double immunofluorescence stainings. Factor XIII subunit a+ cells were found to be highly accumulated at the interface of normal tissue and peritubular infiltrate. In double immunofluorescence labelling systems factor XIII subunit a+ cells were simultaneously labelled by RFD7 and Dako-antimacrophage monoclonal antibodies. They also expressed HLA-DR antigen as revealed by a reaction with RFDR2 monoclonal antibody. The results suggest that monocyte-derived tissue macrophages are present in salivary glands of patients with Sjögren's syndrome and have a characteristic distribution. It can be assumed that they have a role in the demarcation of peritubular inflammation and thus have an effect on the progression of the disease.
In an Italian patient with severe factor XIII deficiency, a novel mutation, Y283C (TAT to TGT), was identified heterozygously by nucleotide sequencing analysis in exon VII of the gene for the A subunit. The presence of this mutation was confirmed using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) analysis in the proband and his brother. Molecular modelling predicts that the mutant molecule would be misfolded. It is probable that the impaired folding of the mutant Y283C A subunit led to its instability, which is at least in part responsible for the factor XIII deficiency of this patient.
A patient is described who had an inhibitor to coagulation factor XIII associated with serum autoantibodies to certain tissues. The relationship of these abnormal findings to practolol therapy suggests that this was practolol-induced lupus erythematosus. Further investigations delineating the site of action of the inhibitor to factor XIII are reported.
We have studied the binding of collagen fibers with platelet proteins using affinity chromatography on collagen-Sepharose. Only a few proteins from a platelet lysate were trapped by this column. When denatured collagen (gelatin) was used as the affinity ligand, the major protein did not bind and was identified as platelet Factor XIII by polyacrylamide gel electrophoresis, immunoprecipitation, and enzymic activity. This is a zymogen form of transglutaminase, which corresponds to the "a" subunit of the coagulation factor in plasma. Immunoglobulins specific for platelet Factor XIII obtained from antiserum raised against plasma Factor XIII were able to initiate platelet aggregation by themselves, in strong contrast to nonspecific antibodies. This specific immunoglobulin-mediated platelet aggregation required the presence of Ca2+. It was inhibited by aspirin and prostacyclin, but not by specific inhibitors for other agonists. These data suggest the possibility that the zymogen form of Factor XIII is located on the surface of platelets and may play a key role as the receptor for collagen-induced platelet aggregation.
The effect of a factor XIII preparation on active epidermal cell migration in vitro has been studied using both floating and attached types of human skin explants in short-term maintenance cultures. In both types of experiment the factor XIII preparation proved to have an inhibitory effect on epidermal cell migration in a dose-dependent fashion. This effect was shown to be independent of both the presence of fibrin and the concentration of calcium ion in the medium. The preparation also showed inhibition of the proliferation of epidermal cells in cell culture.
A 50-year-old woman, with a history of IgG monoclonal gammapathy, presented with meningitis and intradural hematoma of the foramen magnum associated with factor XIII deficiency. The patient died postoperatively of diffuse haemorrhage. Inhibitors to factor XIII are extremely rare and are congenital or acquired. Patients with factor XIII inhibitor can experience severe bleeding, and many died of cerebral haemorrhage. The role of this defect is discussed. We recommend an extensive investigation of haemostasis for patients with both episode of haemorrhagic disorder and monoclonal gammapathy.
Albumin and factor XIII alpha 2 were localized in human blood platelets by immunofluorescence and protein A-colloidal gold immuno-electron microscopy using thin and ultrathin cryosections of mildly fixed human blood platelets. Albumin was found in alpha-granules, co-distributing with beta-thromboglobulin in double label experiments. In platelets directly fixed in plasma, without previous washing, albumin was also localized on the plasma membrane and in the surface connecting system. Factor XIII alpha 2 was localized diffusely through the entire cytoplasmic matrix.