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Case Reports
. 2021 Apr;71(2):191-196.
doi: 10.1007/s13224-020-01389-3. Epub 2020 Nov 17.

Afibrinogenemia Diagnosed During Pregnancy Successfully Managed with Targeted Cryoprecipitate Transfusion: A Case Report

Athulya Shajan  1 , Neetha George  1 , Sareena Gilvaz  1 , Siju V Abraham  2
Affiliations
Case Reports

Afibrinogenemia Diagnosed During Pregnancy Successfully Managed with Targeted Cryoprecipitate Transfusion: A Case Report

Athulya Shajan et al. J Obstet Gynaecol India. 2021 Apr.

Abstract

Background: We report a case of afibrinogenemia in a lady, which was detected for the first time during her pregnancy.

Case: A 24-year-old G4A3 was referred as a case of vaginal bleeding, after a cervical cerclage at 14 weeks of gestation. Elastometry targeted correction of coagulopathy was done initially, and targeted cryoprecipitate transfusion was done to maintain her gestation. She underwent induced vaginal delivery at 34 weeks of gestation. Fourteen days postpartum, the mother and child were discharged home well.

Conclusion: Coagulation factor deficiency should be considered as a rare cause for RPL. Serum fibrinogen level of 50-100 mg/dl during pregnancy seems to be a safe and adequate target to maintain in pregnant patients with afibrinogenemia.

Keywords: Afibrinogenemia; Cryoprecipitate; Fibrinogen; Pregnancy; Rotational thromboelastometry; Viscoelastometry.

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Conflict of interest statement

Conflict of interestThe authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
ROTEM assays. Two ROTEM assays were performed: extrinsically activated assay with tissue factor (EXTEM), and extrinsically activated test with tissue factor and the platelet inhibitor cytochalasin D (FIBTEM). a EXTEM: extrinsically activated assay with tissue factor (EXTEM) showed prolonged CT and shortened A5 and A10. b FIBTEM: extrinsically activated test with tissue factor and the platelet inhibitor cytochalasin D (FIBTEM) showed no clot formation. For the ROTEM assays, the following variables were measured: clotting time (CT [s]), time taken from the start of the test to the time for clot until 2 mm amplitude is reached; alpha is the angle between the central line and a tangent to the curve through 2 mm amplitude point, measured in degrees; A5, A10 (clot amplitude at respective min after the end of CT); and maximum clot firmness (MCF [mm], the maximum amplitude reached during the test). Finally, the lysis index at 60 min (LI60 [%], clot firmness at 60 min as percentage of MCF)
Fig. 2
Fig. 2
Fibrinogen levels and cryoprecipitate transfusion. X axis: days of gestation. Y axis: S fibrinogen (mg/dl) and number of cryoprecipitate transfusion (unit). wks weeks, d days, S —serum, Cryo cryoprecipitate, Tx transfusion, PND postnatal day
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