Dysfibrinogenemia and thrombosis. A case report

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Imen Kraiem
Sami Guermazi
Hela Ben Abid
Balkis Meddeb

Abstract

Background : Congenital dysfibrinogenemia is a functional disorder of the fibrinogen that represents a rare cause of thrombophilia.
Aim : To report a Tunisian case of the association dysfibrinogenemia and thrombosis.
Case : A woman with inherited dysfibrinogenemia associated with mild tendency to bleeding experienced a deep vein thrombosis of the lower-extremity at 26 years of age and a fatal pulmonary embolism a few years later. Paradoxically coagulation function of fibrinogen was markedly altered in vitro with a significantly prolonged prothrombin time, activated partial thromboplastin time and thrombin time, a functional fibrinogen level that was undetected and a severely impaired fibrin polymerisation. The thromboembolic events in the patient could be related to dysfibrinogenemia since the main causes of thrombophilia were excluded.
Conclusion : Although it is rare, this cause of thrombophilia must not be misdiagnosed, systematic measuring of prothrombin time, activated partial thromboplastin time and functional fibrinogen might be helpful.

Keywords:

dysfibrinogenemia, thrombosis, thrombophilia, fibrinogen, fibrin polymerisation

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References

  1. Walter S, Stabler S, Lefkowitz JB. Fibrinogen Denver: a dysfibrinogenemia associated with an abnormal reptilase time and significant bleeding. Haemophilia 2006;12 : 393-7.
  2. Hayes T. Dysfibrinogenemia and thrombosis. Arch Pathol Lab Med 2002;126: 1387-90.
  3. Haverkate F, Samama M. Familial dysfibrinogenemia and thrombophilia. Report on a study of the SSC subcommittee on fibrinogen. Thromb Haemost 1995;73: 151-61.
  4. [Cunningham MT, Brandt JT, Laposata M, Olson JD. Laboratory diagnosis of dysfibrinogenemia. Arch Pathol Lab Med 2002;126: 499-505.
  5. Bentolila S, Samama MM, Conard J, Horellou MH, Ffrench P. Association dysfibrinogénémie et thrombose. A propos d'une famille (fibrinogène Melun) et revue de la littérature. Ann Med Interne (Paris). 1995;146: 575-80.
  6. Ridgway HJ, Brennan SO, Faed JM, George PM. Fibrinogen Otago: a major · chain truncation associated with severe hypofibrinogenemia and recurrent miscarriage. Br J Heamatol 1997;98: 632-9.
  7. [Brennan SO, Davis RL, Lowen R, Ruskova A. Deletion of five residues from the coiled coil fibrinogen (B‚ Asn167_Glu171del) associated with bleeding and hypodysfibrinogenemia. Heamatologica 2009;94: 585-8.
  8. Caen J, Larrieu MJ, Samama M. Dosage du fibrinogène. In : L'Hémostase. Méthodes d'exploration et diagnostic pratique. Paris : l'expansion scientifique 1975: 212-214
  9. Caen J, Larrieu MJ, Samama M. Etude photométrique de la fibrinoformation. In : L'Hémostase. Méthodes d'exploration et diagnostic pratique. Paris : l'expansion scientifique 1975:223- 226.
  10. Caen J, Larrieu MJ, Samama M. Etude du facteur XIII. In : L'Hémostase. Méthodes d'exploration et diagnostic pratique.Paris : l'expansion scientifique 1975:227-233
  11. Marchi R, Mirshahi SS, Soria C, et al. Thrombotic dysfibrinogenemia: fibrinogen “Caracas V” relation between very tight fibrin network and defective clot degradability. Thromb Res 2000;99: 187- 93.
  12. Tarumi T, Martincic D, Thomas A, et al. Familial thrombophilia associated with fibrinogen Paris V : Dusart syndrome. Blood 2000;96: 191-3.
  13. Collet J-P, Soria J, Mirshahi M, et al. Dusart syndrome : a new concept of the relationship between fibrin clot architecture and fibrin clot degradability: hypofibrinolysis related to an abnormal clot structure. Blood 1993;82: 2462-9.
  14. Liu CY, Koehn JA, Morgan FJ. Characterisation of fibrinogen New York 1. A dysfunctional fibrinogen with a deletion of B beta (9-72) corresponding exactly to exon 2 of the gene. J Biol Chem 1985;260: 4390-6.
  15. Engesser L, Koopman J, de Munk G, et al. Fibrinogen Nijmegen: congenital dysfibrinogenemia associated with impaired t-PA mediated plasminogen activation and decreased binding of t-PA. Thromb Haemost 1988; 60: 113-20.
  16. Hamano A, Mimuro J, Aoshima M, et al. Thrombophilic dysfibrinogen Tokyo V with amino acid substitution of ÃAla327Thr: formation of fragile but fibrinolysis-resistant fibrin clots and its relevance to arterial thromboembolism. Blood 2004; 103: 3045-50.
  17. Koopman J, Haverkate F, Lord ST, Grimbergen J, Mannucci PM. Molecular basis of fibrinogen Naples associated with defective thrombin binding and thrombophilia. Homozygous substitution of μ‚ 68 Ala? Thr. J Clin Invest 1992;90: 238-44.
  18. Soria J, Soria C, Collet JP, Mirishahi M, Lu H, Caen JP. Dysfibrinogenemia and thrombosis. Nouv Rev Fr Hematol 1991;33: 457- 9.