Total Laparoscopic Hysterectomy in Factor XI Deficiency: A Case Report

Abstract

Abnormal uterine bleeding (AUB) is a frequent reason for gynaecological consultation and can occasionally reflect rare coagulation disorders. The case study presented herein concerns a 42-year-old para 3 woman (gravida 3, para 3), who exhibited symptoms including irregular heavy menses and the presence of a large uterine myoma. The patient was referred for further evaluation due to symptomatic anaemia and a prolonged activated partial thromboplastin time (aPTT). Haematological evaluation confirmed severe factor XI (FXI) deficiency, with activity levels of 0.3% and 1.24% on repeat testing. As medical therapy proved ineffective in controlling the bleeding over several months, a total laparoscopic hysterectomy (TLH) was planned to minimise the risk of haemorrhage. Preoperative management included the intravenous administration of six units of fresh frozen plasma (FFP) over 24 hours, together with tranexamic acid. The procedure was successfully completed with minimal blood loss (approximately 80 mL), and the patient was discharged 48 hours postoperatively without complications. This case demonstrates the significance of identifying inherited coagulopathies as underlying causes of AUB and underscores the pivotal role of multidisciplinary collaboration, meticulous perioperative planning, and minimally invasive surgical techniques in optimising outcomes and mitigating bleeding risk in women with FXI deficiency.