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

Jie Yan; Donghong Deng; Meiling Luo; Peng Cheng; Bo Chi; Yuan Yuan; Lin Liao; Faquan Lin

doi:10.1016/j.cca.2015.06.002

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

Clin Chim Acta. 2015 Jul 20:447:86-9. doi: 10.1016/j.cca.2015.06.002. Epub 2015 Jun 6.

Authors

Jie Yan¹, Donghong Deng², Meiling Luo¹, Peng Cheng², Bo Chi³, Yuan Yuan³, Lin Liao¹, Faquan Lin⁴

Affiliations

¹ Department of Clinical Laboratory, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China.
² Department of Hematology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China.
³ Department of Obstetrics and Gynecology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China.
⁴ Department of Clinical Laboratory, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China. Electronic address: fqlin1998@163.com.

PMID: 26057201
DOI: 10.1016/j.cca.2015.06.002

Abstract

Background: Dysfibrinogenemia 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.

Methods: A 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.

Results: A 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.

Conclusions: Simultaneous 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.

Keywords: Abortion; Dysfibrinogenemia; Literature review; Misdiagnosis.

Publication types

Case Reports

MeSH terms

Abortion, Induced*
Adult
Afibrinogenemia / diagnosis*
Afibrinogenemia / surgery
Child, Preschool
Diagnostic Errors*
Female
Fetus / abnormalities
Fetus / drug effects
Humans
Male
Pregnancy
Pregnancy Complications / diagnosis*
Pregnancy Complications / surgery