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Viscoelastic testing guided coagulation management in factor VII deficiency for spinal anaesthesia and caesarean section
  1. Uzung Yoon,
  2. Shannon Haley,
  3. Suzanne Huffnagle and
  4. Jane Huffnagle
  1. Department of Anesthesiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
  1. Correspondence to Dr Uzung Yoon; uzyoon{at}


The risks and benefits of spinal anaesthesia must be assessed in patients with coagulation disorders. A woman in her 20s with congenital factor VII (FVII) deficiency (31%) was admitted at 38 weeks for caesarean delivery. A rotational thromboelastometry (ROTEM) analysis showed normal coagulation and spinal anaesthesia was performed safely. A repeated ROTEM analysis after haemostasis and uterine closure showed normal coagulation without fibrinolysis. No prophylactic FVII was administered, resulting in a cost savings of US$12 884. FVII level did not predict bleeding or fibrinolysis and FVII and tranexamic acid were not indicated.

  • Cesarean Section
  • Anaesthesia

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  • Contributors The following authors were responsible for drafting of the text, sourcing and editing of clinical images, investigation results, drawing original diagrams and algorithms, and critical revision for important intellectual content. UY: provided patient care and wrote the manuscript. SHa: provided patient, reviewed and edited the manuscript. SHu: reviewed and edited the manuscript. JH: reviewed and edited the manuscript. The following authors gave final approval of the manuscript: UY, SHa, SHu and JH.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.