30 October 2025
: Case report 
Subgaleal Hematoma in a Pediatric Patient with Factor XI Deficiency: A Case Report of Combined Rare Pathologies
Unusual setting of medical care, Rare coexistence of disease or pathology
Hawra K. Almutawah ABCDEFG 1*, Sami Albttat ABCDEFG 1DOI: 10.12659/AJCR.948814
Am J Case Rep 2025; 26:e948814
Table 1 Timeline of initial presentation and hospital course. This timeline highlights the rapid progression of the hematoma, despite initial therapy, and the escalation of care, including ICU transfer and administration of recombinant activated factor VII (rFVIIa).
| Day | Event |
|---|---|
| −3 | Patient fell from swing (approximately 0.5 m in height); minor head trauma |
| 0 | Presented to Emergency Department with scalp swelling. Computed tomography (CT) confirmed subgaleal hematoma. Laboratory results: activated partial thromboplastin time (aPTT) 71.2 s. Fresh frozen plasma (FFP; 10 mL/kg) initiated |
| 1 | Swelling progressed despite second dose of FFP |
| 2 | Repeat CT showed expansion of hematoma, new signs of cellulitis. Hemoglobin level drop noted. ICU transfer |
| 2–3 | FFP every 8 h (10 mL/kg), single rFVIIa dose (30 μg/kg), intravenous antibiotics started |
| 4 | FXI level returned as 18%. Continued intensive FFP regimen |
| 5–7 | Hematoma stabilized, swelling regressed |
| 8 | Patient discharged home with close follow-up |
| Reference ranges: prothrombin time (11.0–14.5 s), PTT (24.0–40.0 s), FXI (62–125%). | |