Multidisciplinary approach to management of hipofibrinogenaemia in pregnancy, a case report

  • Slagjana Simeonova Krstevska Univerzitetska ginekolosko akuserska klinika Skopje, oddelenje za peripartalnu intenivnu negu
  • Elizabeta Todorovska Republic institute for transfusion medicine
  • Tatjana Makarovska Bojadzieva
  • Elena Petkovic
  • Saso Stojcevski
  • Igor Samardziski
  • Saso Spasovski
  • Violeta Dejanova
  • Radica Grubovic
  • Florije Raka
  • Viktorija Jovanovska
  • Irena Todorovska
  • Vesna Livrinova
  • Aneta Sima
  • Sasa Jovcevski
  • Daniel Milkovski

Sažetak


Inherited fibrinogen disorders introduce risk for recurrent abortions, sub-chorionic haematoma, placental abruption and postpartum haemorrhage. This is a case report of a successful pregnancy outcome in a 37-year old woman with hypofibrinogenaemia. She was referred to a coagulation test in the first trimester because of history of preeclampsia and HELLP syndrome in previous pregnancy. Hypofibrinogenaemia was diagnosed with fibrinogen level of 0.7 g/L. During the pregnancy she was regularly monitored for fibrinogen levels and multiple cryoprecipitate concentrates were given. She delivered at 39th gestation week, with elective caesarean section under general anaesthesia. There was one episode of postpartum haemorrhage treated with 2 units of red blood cells, repeated infusions of cryoprecipitate to obtain the level of fibrinogen of 2 g/L. She was discharged on the 6th postpartum day in a good condition. In these disorders levels of fibrinogen should be higher than 1 g/L during pregnancy or 2 g/L in case of caesarean section for successful prenatal and peripartal management.

Biografije autora

Slagjana Simeonova Krstevska, Univerzitetska ginekolosko akuserska klinika Skopje, oddelenje za peripartalnu intenivnu negu
Specijalista ginekologije i akuserstva, docent na katedru ginekologije i akuserstva, Medicinski fakultet, Skopje
Elizabeta Todorovska, Republic institute for transfusion medicine

spec transfuzione medicine, PhD

Tatjana Makarovska Bojadzieva

prof dr, spec transfuzione medicine, PhD

Elena Petkovic

specijalista transfuzione medicine, dr medicinskih nauka, asistent

Saso Stojcevski

spec ginekologije i akuserstva, subspecijalista uroginekologije, dr medicinskih nauka, docent

Igor Samardziski

spec ginekologije i akuserstva, perinatolog, dr medicinskih nauka, docent

Saso Spasovski

spec anesteziologije

Violeta Dejanova

specijalista transfuzione medicine, dr med nauka

Radica Grubovic

spec transfuziologije, dr med nauka

Florije Raka

specialist transfuzione medicine

Viktorija Jovanovska

spec ginekologije, dr med nauka, docent

Irena Todorovska

spec ginekologije i akuserstva, subspecijalista perinatologije, asistent

Vesna Livrinova

spec ginekologije, perinatolog, dr med nauka, docent

Aneta Sima

spec ginekologije, docent

Sasa Jovcevski

spec ginekologije i akuserstva

Daniel Milkovski

spec ginekologije i akuserstva, asistent

Reference

1. Clark P. Changes of hemostasis variables during pregnancy. Semin Vasc Med. 2003 Feb;3(1):13-24./ https://www.ncbi.nlm.nih.gov/pubmed/15199489
2 Jarmila A. Zdanowicz, Daniel Surbek . Patient blood management in obstetrics – Review. Transfusion and Apheresis Science. August 2019Volume 58, Issue 4, Pages 412–415/
3. De Moerloose P, Casini A, Neerman-Arbez M. Congenital fibrinogen disorders: an update. Semin Thromb Hemost 2013; https://www.ncbi.nlm.nih.gov/pubmed/23852822
4. Casini A, de Moerloose P. Management of congenital quantitative fibrinogen disorders: a Delphi consensus. Haemophilia 2016; https://www.ncbi.nlm.nih.gov/pubmed/27640400
5. Pritchard JA. Chronic hypofibrinogenemia and frequent placental abruption. Report of a case. Obstet Gynecol 1961/ https://www.ncbi.nlm.nih.gov/pubmed/13738090
6. L. Hahn, P. A. Lundberg, A. C. Teger‐Nilsson, CONGENITAL HYPOFIBRINOGENAEMIA AND RECURRENT ABORTION. CASE REPORT, BJOG, October 1978 //https://obgyn.onlinelibrary.wiley.com/doi/abs/10.1111/j.1471-0528.1978.tb15605.x
7. Teraoka Y, Miyoshi H, Oshima K, Urabe S, Tanaka N, Kudo Y. Prenatal and peripartum management of patients with hypofibrinogenemia resulted in two successful deliveries. Case Rep Obstet Gynecol 2017; https://www.ncbi.nlm.nih.gov/pubmed/28286684

8. Mensah PK, Oppenheimer C, Watson C, Pavord S. Congenital afibrinogenaemia in pregnancy. Haemophilia 2011; https://onlinelibrary.wiley.com/doi/full/10.1046/j.1365-2141.2000.01993.x

9.Lebreton A, Casini A, Alhayek R, Kouteich KL, Neerman-Arbez M, de Moerloose P. Successful pregnancy under fibrinogen substitution in a woman with congenital afibrinogenaemia complicated by a postpartum venous thrombosis. Haemophilia 2015; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5815641/
10. Michael W. Mosesson. Dysfibrinogenemia and Thrombosis. Semin Thromb Hemost 1999; 25(3): 311-319. DOI: 10.1055/s-2007-994933; https://www.thieme-connect.de/products/ejournals/abstract/10.1055/s-2007-994933

11. Yan J, Deng D, Cheng P, Liao L, Luo M, Lin F. Management of dysfibrinogenemia in pregnancy: A case report. J Clin Lab Anal. 2018 Mar;32(3). doi: 10.1002/jcla.22319. Epub 2017 Sep 26.

12. Munoz J, Schering J, Lambing A, Neal S, Goyert G, Green PM, Hanbali A, Raman S, Kuriakose P. The dilemma of inherited dysfibrinogenemia during pregnancy. Blood Coagul Fibrinolysis. 2012 Dec;23(8):775-7. doi: 10.1097/MBC.0b013e328358e96d.

13. Kobayashi T, Kanayama N, Tokunaga N, Asahina T, Terao T. Prenatal and peripartum management of congenital afibrinogenaemia. Br J Haematol 2000; https://www.ncbi.nlm.nih.gov/pubmed/10848826


14. Shapiro SE, Diagnosis and management of dysfibrinogenemia. Clinical Advances in Heematology&Oncology.2018.16(9):602-605). https://www.hematologyandoncology.net/archives/september-2018/diagnosis-and-management-of-dysfibrinogenemia/

15. Kohler HP. Interaction between FXIII and fibrinogen. Blood. 2013; 121 (11): 1931–1932). https://ashpublications.org/blood/article/121/11/1931/31051/Interaction-between-FXIII-and-fibrinogen
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2020/04/04
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