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PubMed This is a summary of 20 peer-reviewed journal articles Updated
Hematology

Are Factor XIII Carriers at Risk During Surgery & Birth?

At a Glance

While Factor XIII deficiency carriers usually have enough factor activity for daily life, major stress like surgery or childbirth can overwhelm their supply. This increases the risk of delayed bleeding and postpartum hemorrhage. Carriers should consult a hematologist for specific testing and preventative treatments before major procedures.

In this answer

2 sections

01

Why Surgery and Childbirth Increase Your Risk

02

Preparing for Procedures and Pregnancy

If you are a carrier of Factor XIII (Factor 13) deficiency, you likely have between 20% and 60% of normal factor activity. For everyday life, this is almost always enough to keep you safe—carriers typically do not experience the spontaneous bleeding that people with severe deficiency face [1][2]. However, during times of major physical stress, such as surgery, severe trauma, or childbirth, your body’s demand for Factor XIII increases, and you may be at a higher risk for abnormal bleeding [3][2][4].

Why Surgery and Childbirth Increase Your Risk

Factor XIII is a protein in your blood that is essential for stabilizing blood clots and helping wounds heal properly. When you have a major surgery or give birth, your body needs to form strong, lasting clots to stop the bleeding.

While everyday cuts and scrapes do not test your body’s clotting system very hard, a major physical challenge can overwhelm your partial supply of Factor XIII [1][5]. If your levels are not sufficient, the blood clots your body forms may be weak and break down too early, leading to delayed bleeding (bleeding that starts hours or days after the procedure) and poor wound healing [6][7]. Warning signs of delayed bleeding at home include continuous oozing from an incision or sudden, severe swelling and bruising around a surgical site [7][8].

In the case of childbirth, postpartum hemorrhage (heavy bleeding after delivery) is a known risk for carriers of Factor XIII deficiency and requires careful management by your obstetric care team [3][9].

Preparing for Procedures and Pregnancy

Standard blood clotting tests—like the PT and aPTT panels you might get before surgery—will almost always show up as completely normal in people with Factor XIII deficiency [10][11]. This is because these routine tests measure how fast a clot forms, but Factor XIII does its job after the clot is formed to hold it together [11][12]. Because of this, you cannot rely on routine pre-surgery blood work to capture your specific risk [10][8]. You must be your own advocate.

If you are planning a surgery, a major dental procedure (like tooth extractions), or are pregnant, it is crucial to take the following steps:

  • Get your levels checked: Have your specific Factor XIII activity levels measured using a quantitative Factor XIII activity assay before any planned procedure or as part of your pregnancy care [13][14].
  • Consult a hematologist: Work with a hematologist (a doctor who specializes in blood disorders) well in advance [15][16]. They can evaluate your baseline levels and determine your specific risk.
  • Discuss preventative treatment: Depending on your levels and the complexity of the procedure, your doctor may recommend medications to help prevent excessive bleeding. This might include prophylactic replacement therapy (giving you donor or synthetic Factor XIII to temporarily boost your levels) [17][18] or antifibrinolytic medications like tranexamic acid, which help slow the breakdown of blood clots [19][20].
  • Review all medications: Because your clots may already be prone to breaking down early, taking medications that interfere with platelets—like aspirin, ibuprofen, or other NSAIDs—can significantly increase your risk of severe bleeding [13][8]. Review all medications and supplements with your doctor.
  • Inform your entire team: Ensure your surgeon, anesthesiologist, and obstetrician are fully aware of your carrier status and have a clear communication line to your hematologist [15][16]. For example, if you are pregnant, your anesthesiologist and hematologist must coordinate beforehand to determine if it is safe for you to receive an epidural [15][16].

(Note: Because Factor XIII deficiency is a genetic condition, your baby could also inherit the deficiency or carrier status depending on your partner’s genetics [1]. You may wish to discuss newborn testing with your pediatrician.)

Common questions in this guide

Can You Develop Factor XIII Deficiency Later in Life?Why Does Factor XIII Only Need Monthly Infusions?Factor XIII Child Bumped Head? What to Do ImmediatelyWhy Do I Get Cigarette-Paper Scars with FXIII Deficiency?Does Factor XIII Deficiency Cause Permanent Joint Damage?What to Put on a Factor XIII Medical Alert BraceletHow Often Are Factor XIII Infusions in Pregnancy?Can Plasma Treat Factor XIII Deficiency Emergencies?Can I Have Factor XIII With a Normal Clot Test?Tretten vs Corifact for Factor XIII: What's the Difference?
Do Factor XIII carriers have bleeding problems in daily life?
For everyday life, Factor XIII carriers usually have enough factor activity to stay safe. They typically do not experience the spontaneous bleeding that affects people with severe deficiency, though major surgeries or trauma can increase their risk.
Why do routine pre-surgery blood tests show up normal for Factor XIII carriers?
Routine clotting tests like the PT and aPTT measure how fast a blood clot forms. Because Factor XIII works to stabilize the clot after it has already formed, these standard tests will usually appear completely normal even if your Factor XIII levels are low.
What is delayed bleeding?
Delayed bleeding is bleeding that starts hours or days after a surgical procedure or injury, rather than immediately. In Factor XIII carriers, this happens because the initial blood clot forms properly but is weak and breaks down too early.
What treatments can prevent bleeding during childbirth or surgery for a Factor 13 carrier?
Your hematologist may recommend prophylactic replacement therapy to temporarily boost your Factor XIII levels before a procedure. They might also prescribe antifibrinolytic medications, such as tranexamic acid, which help slow the breakdown of blood clots.
Can I get an epidural during labor if I am a Factor XIII carrier?
Receiving an epidural safely requires careful planning. Your obstetrician, anesthesiologist, and hematologist must coordinate beforehand to evaluate your specific factor levels and determine if the procedure is safe for you.

Questions for Your Doctor

5 questions

  • •What is my exact Factor XIII activity percentage, and what is your threshold for treating me preventatively before surgery or delivery?
  • •Will you coordinate directly with my hematologist and anesthesiologist to ensure a safe plan is in place, including for options like an epidural?
  • •Should I be prescribed antifibrinolytic medications or receive Factor XIII replacement therapy before my procedure to prevent delayed bleeding?
  • •If I experience signs of delayed bleeding at home, such as oozing or sudden swelling, who should I contact immediately?
  • •Will the hospital pharmacy have Factor XIII concentrate in stock when I go into labor or have my surgery?

Questions for You

4 questions

  • •Have I or any blood relatives ever experienced unexplained bleeding or delayed wound healing after past surgeries or dental work?
  • •Have I informed all members of my surgical or obstetric care team about my Factor XIII carrier status?
  • •Am I currently taking any NSAIDs, aspirin, or supplements that could further increase my bleeding risk?
  • •Do I have a hematologist I trust to help me plan for major medical procedures?

References

References (20)
  1. 1

    Abnormally Prolonged Bleeding After an Arthroscopic Knee Reconstruction Because of an Inherited Factor XIII Deficiency: A Case Report.

    Wattakavanich N, Boonrod A, Wanitpongpun C, Tharakulphan S

    JBJS case connector 2021; (11(4)) doi:10.2106/JBJS.CC.21.00419.

    PMID: 35102034
  2. 2

    Novel Insights into Heterozygous Factor XIII Deficiency.

    Dorgalaleh A

    Seminars in thrombosis and hemostasis 2024; (50(2)):200-212 doi:10.1055/s-0043-1764471.

    PMID: 36940714
  3. 3

    Mild factor XIII deficiency and concurrent hypofibrinogenemia: effect of pregnancy.

    Kaveney AD, Philipp CS

    Blood coagulation & fibrinolysis : an international journal in haemostasis and thrombosis 2016; (27(4)):457-60 doi:10.1097/MBC.0000000000000448.

    PMID: 26575494
  4. 4

    Heterozygosity in factor XIII genes and the manifestation of mild inherited factor XIII deficiency.

    Singh S, Pezeshkpoor B, Jamil MA, et al.

    Journal of thrombosis and haemostasis : JTH 2024; (22(2)):379-393 doi:10.1016/j.jtha.2023.09.032.

    PMID: 37832789
  5. 5

    Recurrent Intramuscular Hematoma Revealing Moderate Congenital Factor XIII Deficiency.

    Ben Halima N, Riahi S, Mazlout I, et al.

    Cureus 2025; (17(10)):e95841 doi:10.7759/cureus.95841.

    PMID: 41328102
  6. 6

    Acute Occlusion of the Ventriculoperitoneal Shunt Due to Factor XIII Deficiency-related Postoperative Hemorrhage: A Case Report.

    Yamanishi S, Kimura H, Hayashi H, et al.

    NMC case report journal 2021; (8(1)):573-577 doi:10.2176/nmccrj.cr.2020-0330.

    PMID: 35079519
  7. 7

    Delayed Postoperative Spinal Epidural Hematoma After Thoracic OPLL Surgery: A Case Report and Literature Review.

    Takei H, Ohba T, Tanaka N, et al.

    Clinical case reports 2026; (14(1)):e71810 doi:10.1002/ccr3.71810.

    PMID: 41497778
  8. 8

    A Case of Factor XIII Deficiency Identified by Recurrent Postoperative Bleeding After Tonsillectomy.

    Teramura T, Sakai A, Hamada M, et al.

    Clinical case reports 2026; (14(2)):e72006 doi:10.1002/ccr3.72006.

    PMID: 41659946
  9. 9

    Medical and Surgical Management of Postpartum Hemorrhage in a Woman with Factor XIII Deficiency.

    Cheng M, Nassim J, Angha A, et al.

    Case reports in obstetrics and gynecology 2016; (2016()):7963874 doi:10.1155/2016/7963874.

    PMID: 27635271
  10. 10

    Acquired factor XIII deficiency in two patients with bleeding events during veno-venous extracorporeal membrane oxygenation treatment.

    Ito A, Iwashita Y, Esumi R, et al.

    Journal of artificial organs : the official journal of the Japanese Society for Artificial Organs 2020; (23(3)):283-287 doi:10.1007/s10047-019-01148-w.

    PMID: 31834529
  11. 11

    Recurrent Bleeding after Head Trauma Caused by Acquired Factor XIII Deficiency.

    Wakabayashi N, Nishioka H, Yuzuriha S

    Plastic and reconstructive surgery. Global open 2022; (10(2)):e4109 doi:10.1097/GOX.0000000000004109.

    PMID: 35186643
  12. 12

    Congenital factor XIII deficiency caused by F13A1 gene mutations presenting with intracranial hemorrhage: a case report.

    Wang H, Yang R, Li J

    Frontiers in pediatrics 2025; (13()):1732065 doi:10.3389/fped.2025.1732065.

    PMID: 41488895
  13. 13

    Fracture neck of femur in Factor XIII deficiency: Was better outcome possible?

    Vijayan S, Pai H, Shah H, Bhaskaranand N

    Journal of family medicine and primary care 2017; (6(3)):651-653 doi:10.4103/2249-4863.222011.

    PMID: 29417025
  14. 14

    Subgaleal Hematoma in a Female With Normal Coagulation Tests.

    Ataei-Azimi S, Bos MHA, Rahimi H, Mansouritorghabeh H

    Case reports in hematology 2025; (2025()):5481806 doi:10.1155/crh/5481806.

    PMID: 40919234
  15. 15

    Dental Management of Factor XIII Deficiency Patients: A Case Series.

    Pai NG, Mehta LK, Padhye NM, Sayed ZM

    International journal of clinical pediatric dentistry 2020; (13(3)):299-302 doi:10.5005/jp-journals-10005-1760.

    PMID: 32903982
  16. 16

    Pyopneumothorax Secondary to Pulmonary Tuberculosis Superadded by Congenital Factor XIII Deficiency: A Case Report.

    Bajpai J, Tewari J, Roy S, et al.

    Cureus 2023; (15(10)):e47350 doi:10.7759/cureus.47350.

    PMID: 38022233
  17. 17

    Long Term Follow up Study on a Large Group of Patients with Congenital Factor XIII Deficiency Treated Prophylactically with Fibrogammin P®.

    Naderi M, Karimi M, Hosseini MS, et al.

    Iranian journal of pharmaceutical research : IJPR 2016; (15(2)):635-40.

    PMID: 27642336
  18. 18

    Factor XIII Deficiency: A Review of Clinical Presentation and Management.

    Pelcovits A, Schiffman F, Niroula R

    Hematology/oncology clinics of North America 2021; (35(6)):1171-1180 doi:10.1016/j.hoc.2021.07.009.

    PMID: 34607717
  19. 19

    Massive recurrent post-tonsillectomy bleedings revealing a transient factor XIII deficiency in a 10-year-old boy. A case report.

    Jankovic M, Choucair ML, Hallak B, et al.

    International journal of pediatrics & adolescent medicine 2019; (6(2)):55-57 doi:10.1016/j.ijpam.2019.05.006.

    PMID: 31388547
  20. 20

    Rare Bleeding Disorders: Strategy for Diagnosis and Management- A Tertiary Care Experience from North India.

    Langer S, Dahiya S, Kalra M, et al.

    Indian journal of hematology & blood transfusion : an official journal of Indian Society of Hematology and Blood Transfusion 2026; (42(1)):192-197 doi:10.1007/s12288-025-01965-5.

    PMID: 41522530

This page provides educational information about bleeding risks for Factor XIII carriers. It is not medical advice; always consult your hematologist and surgical team to plan for your specific procedure.

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