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 2 Timeline of readmission and management of recurrent subgaleal hematoma.
| Day (after discharge) | Event |
|---|---|
| +2 days | Patient re-presented to Emergency Department with expanding scalp swelling; no history of new trauma |
| +2 days | Computed tomography (CT) showed acute-on-chronic subgaleal hematoma with redistribution |
| +2 days | Laboratory results: activated partial thromboplastin time (aPTT) 72.8 s, prothrombin time (PT) 16.2 s, international normalized ratio 1.19. Factor XI (FXI) level not available yet |
| +2 days | Admitted to pediatric ward. Fresh frozen plasma (FFP) intensified: 20 mL/kg loading dose, then 10 mL/kg every 8 h. rFVIIa (30 μg/kg) given stat. Tranexamic acid started at 10 mg/kg intravenous 3 times daily |
| +3 to +14 days | Daily clinical monitoring. Hematoma stabilized; no further enlargement. FXI repeated twice: 52% and 44%. aPTT remained prolonged |
| +14 days | Discharged with stable condition, resolving hematoma, and prolonged aPTT (89.7 s) |
| Follow-up | Clinically stable with no recurrence |
| Reference ranges: PT (11.0–14.5 s), PTT (24.0–40.0 s), FXI (62–125%). The timeline underscores the prolonged coagulation abnormalities despite intensive replacement therapy and highlights the successful stabilization of the hematoma with a multi-modal approach. | |