From the Research
The normal factor XIII level in neonates ranges from 27% to 78% of adult values at birth, as reported in the most recent and highest quality study available 1. This level gradually increases during the first few months of life, reaching adult values by approximately 6 months of age. Factor XIII is a coagulation factor responsible for stabilizing fibrin clots by cross-linking fibrin molecules, making them more resistant to fibrinolysis. Despite having lower levels than adults, healthy neonates typically have sufficient factor XIII for adequate hemostasis. These physiologically lower levels reflect the developmental maturation of the hemostatic system in newborns. Some key points to consider include:
- Severe factor XIII deficiency (levels below 1%) is rare but can cause serious bleeding complications including umbilical cord bleeding and intracranial hemorrhage.
- Moderate deficiency (1-4%) may present with delayed bleeding after trauma, while mild deficiency (5-30%) is often asymptomatic.
- If factor XIII deficiency is suspected in a neonate with unusual bleeding, specific factor XIII activity assays should be performed, as routine coagulation tests like PT and PTT are typically normal even in severe deficiency, as noted in 2 and 3. The most recent study on coagulation standards in healthy newborns and infants 1 provides the most accurate and up-to-date information on this topic, and its findings should be prioritized in clinical decision-making.