Retrochorionic hematoma in congenital afibrinogenemia: resolution with fibrinogen concentrate infusions.
Without treatment, pregnancies in patients with congenital afibrinogenemia terminate in miscarriage at 5-6 weeks of gestation. Animal model studies have suggested that implantation site bleeding contributes to miscarriage in afibrinogenemia; however, retrochorionic hematoma in human congenital afibrinogenemia has not been previously observed. A patient with congenital afibrinogenemia receiving fibrinogen prophylaxis developed a retrochorionic hematoma in the first trimester. With continuous intensified fibrinogen concentrate replacement the hematoma resolved over 6 weeks, and the patient delivered a healthy infant. Median fibrinogen levels in the first trimester were 48 mg/dL and in second and third trimester 44 mg/dL. Median fibrinogen levels under 60 mg/dL may be adequate to maintain pregnancy in patients with congenital afibrinogenemia, although it is possible that higher levels might reduce the risk of hemorrhagic events.
Aygören-Pürsün
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E
Department of Pediatric Hematology, Oncology and Hemostasis, Johann Wolfgang Goethe University Hospital, Frankfurt am Main, Germany. eap@em.uni-frankfurt.de
Martinez Saguer
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I
Rusicke
E
E
Louwen
F
F
Geka
F
F
Ivaskevicius
V
V
Oldenburg
J
J
Klingebiel
T
T
Kreuz
W
W
D000328:Adult; D000347:Afibrinogenemia / Q000150:complications / Q000151:congenital / Q000188:drug therapy*; D001779:Blood Coagulation Factors / Q000627:therapeutic use*; D005260:Female; D005340:Fibrinogen / Q000627:therapeutic use*; D006406:Hematoma / Q000188:drug therapy*; D006801:Humans; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic / Q000188:drug therapy*; D011256:Pregnancy Outcome; D014592:Uterine Hemorrhage / Q000188:drug therapy*
D001779:Blood Coagulation Factors; D005340:Fibrinogen