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Serendipitous Discovery of Factor VII Deficiency and the Ensuing Dilemma
Jayadev M. UMAKANTHAN, Prajwal DHAKAL, Krishna GUNDABOLU, Scott A. KOEPSELL and Muhamed BALJEVIC
ABSTRACT
Congenital factor VII deficiency is a challenging disorder to manage, as it is associated with varied genotypes that do not clinically correlate with a bleeding phenotype. Individuals with severe factor VII deficiency (FVII: c <1%) might be asymptomatic, while patients with moderate deficiency (FVII: c level >5%) may experience severe hemorrhages. In modern medicine, due to extensive routine pre-operative laboratory testing, clinically asymptomatic patients without any bleeding history might be incidentally discovered, raising clinical dilemmas. Careful consideration of bleeding versus thrombosis risk has to be made in such cases, especially in the elderly. Clinical history of no prior bleeding complications may be a reassuring factor. Minimal required replacement dosing of recombinant activated factor VII can be given peri-operatively in such situations, with close monitoring.
Keywords: Factor VII deficiency, Factor VII replacement, bleeding.