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Hyperfibrinogenolysis in disseminated adenocarcinoma
K Meijer1, W M Smid, S Geerards
1Division of Thrombosis, Haemostasis and Rheology, University Hospital Groningen, The Netherlands. k.meijer@int.azg.nl
Summary
A lung adenocarcinoma caused primary hyperfibrinogenolysis, a bleeding disorder. Treatment with tranexamic acid and cryoprecipitate was effective until tumor progression led to disseminated intravascular coagulation.
Area of Science:
- Oncology
- Hematology
- Pathology
Background:
- Acquired bleeding disorders can present with complex coagulation abnormalities.
- Primary hyperfibrinogenolysis is a rare hemostatic disorder characterized by excessive breakdown of fibrinogen.
- Malignancy is an important, though often overlooked, cause of acquired hyperfibrinogenolysis.
Observation:
- A 42-year-old woman presented with a new bleeding tendency.
- Coagulation studies revealed markedly low fibrinogen and alpha2-antiplasmin, with normal levels of antithrombin III, protein C, and protein S.
- A diagnosis of primary hyperfibrinogenolysis was suspected, and a lung adenocarcinoma was identified as the likely cause.
Findings:
- The patient's hyperfibrinogenolysis was initially managed successfully with tranexamic acid and cryoprecipitate.
- Tumor progression correlated with the worsening of hyperfibrinogenolysis, ultimately leading to diffuse intravascular coagulation (DIC).
- This case highlights the potential for malignancy-induced hyperfibrinogenolysis to mimic other bleeding disorders.
Implications:
- Early recognition of hyperfibrinogenolysis in the context of malignancy is crucial for timely intervention.
- Effective management requires addressing both the underlying malignancy and the hemostatic defect.
- Understanding the differential diagnosis of coagulation disorders in cancer patients is essential for appropriate patient care.