Quantitative fibrinogen disorders, including afibrinogenemia and hypofibrinogenemia, are defined by the complete absence or reduction of fibrinogen, respectively. The diagnosis is based on the measurement of fibrinogen activity and antigen levels, which define the severity of this monogenic disorder. Afibrinogenemia is the result of homozygosity or combined heterozygosity for the causative mutations, whereas monoallelic mutations lead to hypofibrinogenemia. The bleeding phenotype varies in accordance with fibrinogen levels, ranging generally from frequent and often life-threatening bleeding in afibrinogenemia to the absence of symptoms, or mild bleeding symptoms in mild hypofibrinogenemia. The main treatment for quantitative fibrinogen disorders is fibrinogen supplementation. Despite low fibrinogen levels, a tendency for thrombosis is a characteristic of these disorders and may be exacerbated by fibrinogen supplementation. The management of surgery and pregnancy presents significant challenges regarding the amount of fibrinogen replacement and the need for thromboprophylaxis. The objective of this article is to present 4 clinical scenarios that illustrate common clinical challenges and to propose strategies for managing bleeding, thrombosis, surgery, and pregnancy.
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HOW I TREAT|
February 20, 2025
How I treat quantitative fibrinogen disorders
Alessandro Casini
Alessandro Casini
Division of Angiology and Hemostasis, University Hospitals of Geneva, Geneva, Switzerland; and Department of Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
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Blood (2025) 145 (8): 801–810.
Article history
Submitted:
August 2, 2024
Accepted:
November 14, 2024
First Edition:
December 19, 2024
Citation
Alessandro Casini; How I treat quantitative fibrinogen disorders. Blood 2025; 145 (8): 801–810. doi: https://doi.org/10.1182/blood.2024025712
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