Afibrinogenemia Diagnosed During Pregnancy Successfully Managed with Targeted Cryoprecipitate Transfusion: A Case Report
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CASE REPORT
Afibrinogenemia Diagnosed During Pregnancy Successfully Managed with Targeted Cryoprecipitate Transfusion: A Case Report Athulya Shajan1 · Neetha George1 · Sareena Gilvaz1 · Siju V. Abraham2 Received: 18 May 2020 / Accepted: 21 October 2020 © Federation of Obstetric & Gynecological Societies of India 2020
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 · Pregnancy · Fibrinogen · Cryoprecipitate · Viscoelastometry · Rotational thromboelastometry
Introduction Afibrinogenemia and hypofibrinogenemia, respectively, refer to the absence and reduced levels of fibrinogen (also known as coagulation factor I) in the blood, a protein that is essential in the coagulation process [1]. Afibrinogenemia is rare disorder affecting one in a million pregnancy [2]. Affected individuals may be susceptible Athulya Shajan MBBS, Junior Resident in Department of Obstetrics and Gynaecology, Jubilee Mission Medical College and Research Institute, Thrissur, Kerala, India. Neetha George MS, FICOG, Associate Professor in the Department of Obstetrics and Gynaecology, Jubilee Mission Medical College and Research Institute, Thrissur, Kerala, India. Sareena Gilvaz MD DGO, Professor and Head of the Department of Obstetrics and Gynaecology, Jubilee Mission Medical College and Research Institute, Thrissur, Kerala, India. Siju V Abraham MD, Assistant Professor in the Department of Emergency Medicine, Jubilee Mission Medical College and Research Institute, Thrissur, Kerala, India. * Athulya Shajan [email protected] 1
Department of Obstetrics and Gynaecology, Jubilee Mission Medical College and Research Institute, Thrissur, Kerala, India
Department of Emergency Medicine, Jubilee Mission Medical College and Research Institute, Thrissur, Kerala, India
2
to severe bleeding episodes, particularly during infancy and childhood [2]. We report a case of afibrinogenemia, diagnosed during pregnancy, in a woman with recurrent pregnancy loss.
Case Report A 24-year-old third gravida, with a history of three abortions in the past, was referred from another hospital with complaints of vaginal bleeding since 2 days after a cervical cerclage procedure. She had undergone encirclage suspecting cervical incompetence, at 14 weeks of gestation. She was started on progesterone, aspirin and low molecula
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