title: Dysfibrinogenemia in a patient undergoing artificial abortion after misdiagnosis and review of the literature.
abstract: BACKGROUND
  Dysfibrinogenemia is characterized by dysfunction induced by an abnormal fibrinogen molecule structure that results in blood coagulation dysfunction. The clinical manifestations are diverse. Dysfibrinogenemia is misdiagnosed or miss diagnosis in the absence of an appropriate laboratory examination. Treatment during pregnancy or surgery is suggested to be adapted to the individual patient.
  
  
  METHODS
  A 26-y-old woman took drugs that may cause fetal malformation during early pregnancy. She required an artificial abortion in a local municipal hospital and was misdiagnosed with hypofibrinogenemia.
  
  
  RESULTS
  A preoperative coagulation test revealed a fibrinogen concentration of 0.56g/l, prompting a diagnosis of hypofibrinogenemia at the local municipal hospital. She underwent fresh plasma and cryoprecipitate infusion with a poor outcome. However, the coagulation test results in our hospital showed a prothrombin time of 12.60s, activated partial thromboplastin time of 34.60s, thrombin time of 25.30s, and fibrinogen concentrations of 0.51g/l (Clauss method) and 3.82g/l (immunoturbidimetry). Ultrasound examination showed early intrauterine pregnancy with a fetal heartbeat. The patient was finally diagnosed with dysfibrinogenemia. A detailed inquiry regarding her personal and family histories revealed no abnormal bleeding or thrombotic events. Therefore, other therapies were not conducted and operation was successfully performed. No abnormal bleeding or thrombotic events occurred postoperatively.
  
  
  CONCLUSIONS
  Simultaneous determination of fibrinogen concentrations using the Clauss method, prothrombin time-derived method, and immunoturbidimetry as well as measurement of the thrombin time, reptilase time, prothrombin time, activated partial thromboplastin time and so on can effectively distinguish dysfibrinogenemia from other diseases. Special treatment of asymptomatic dysfibrinogenemia is not needed during pregnancy or surgery in the absence of bleeding or thrombotic events in the patient's personal or family history.
authors.affiliation: Department of Clinical Laboratory, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China.
authors.forename: Jie
authors.initials: J
authors.lastname: Yan
authors.affiliation: Department of Hematology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China.
authors.forename: Donghong
authors.initials: D
authors.lastname: Deng
authors.affiliation: Department of Clinical Laboratory, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China.
authors.forename: Meiling
authors.initials: M
authors.lastname: Luo
authors.affiliation: Department of Hematology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China.
authors.forename: Peng
authors.initials: P
authors.lastname: Cheng
authors.affiliation: Department of Obstetrics and Gynecology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China.
authors.forename: Bo
authors.initials: B
authors.lastname: Chi
authors.affiliation: Department of Obstetrics and Gynecology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China.
authors.forename: Yuan
authors.initials: Y
authors.lastname: Yuan
authors.affiliation: Department of Clinical Laboratory, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China.
authors.forename: Lin
authors.initials: L
authors.lastname: Liao
authors.affiliation: Department of Clinical Laboratory, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China. Electronic address: fqlin1998@163.com.
authors.forename: Faquan
authors.initials: F
authors.lastname: Lin
mesh_terms: D000028:Abortion, Induced; D000328:Adult; D000347:Afibrinogenemia / Q000175:diagnosis* / Q000601:surgery; D002675:Child, Preschool; D003951:Diagnostic Errors; D005260:Female; D005333:Fetus / Q000002:abnormalities / Q000187:drug effects; D006801:Humans; D008297:Male; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis* / Q000601:surgery
keywords: Abortion; Dysfibrinogenemia; Literature review; Misdiagnosis