Dysfibrinogenemia in a patient undergoing artificial abortion after misdiagnosis and review of the literature

Abstract

BackgroundDysfibrinogenemia is characterized by dysfunction induced by an abnormal fibrinogen molecule structure that results in blood coagulation dysfunction. The clinical manifestations are diverse. Dysfibrinogenemia is misdiagnosed or miss diagnosis in the absence of an appropriate laboratory examination. Treatment during pregnancy or surgery is suggested to be adapted to the individual patient. MethodsA 26-y-old woman took drugs that may cause fetal malformation during early pregnancy. She required an artificial abortion in a local municipal hospital and was misdiagnosed with hypofibrinogenemia. ResultsA preoperative coagulation test revealed a fibrinogen concentration of 0.56g/l, prompting a diagnosis of hypofibrinogenemia at the local municipal hospital. She underwent fresh plasma and cryoprecipitate infusion with a poor outcome. However, the coagulation test results in our hospital showed a prothrombin time of 12.60s, activated partial thromboplastin time of 34.60s, thrombin time of 25.30s, and fibrinogen concentrations of 0.51g/l (Clauss method) and 3.82g/l (immunoturbidimetry). Ultrasound examination showed early intrauterine pregnancy with a fetal heartbeat. The patient was finally diagnosed with dysfibrinogenemia. A detailed inquiry regarding her personal and family histories revealed no abnormal bleeding or thrombotic events. Therefore, other therapies were not conducted and operation was successfully performed. No abnormal bleeding or thrombotic events occurred postoperatively. ConclusionsSimultaneous determination of fibrinogen concentrations using the Clauss method, prothrombin time-derived method, and immunoturbidimetry as well as measurement of the thrombin time, reptilase time, prothrombin time, activated partial thromboplastin time and so on can effectively distinguish dysfibrinogenemia from other diseases. Special treatment of asymptomatic dysfibrinogenemia is not needed during pregnancy or surgery in the absence of bleeding or thrombotic events in the patient's personal or family history.