Total knee arthroplasty in a patient with hypofibrinogenemia

A low-dose therapy of fibrinogen supplement during perioperative period of total knee arthroplasty in an asymptomatic man with congenital dysfibrinogenemia: A case report

RATIONALE

Congenital dysfibrinogenemia (CD) is a rare coagulation system disease that is often treated without unified management. Individualized treatment thereof presents clinicians with great challenges.

PATIENT CONCERNS

A patient who was about to undergo total knee arthroplasty was found to have CD.

DIAGNOSES

Coagulation screening revealed low fibrinogen, prolonged thrombin time, minor prolonged prothrombin time, and normal activated partial thromboplastin time were detected during admission, but no abnormal personal and family history findings were observed. Therefore, CD and hypofibrinogenemia were suspected. The gene sequencing confirmed the diagnosis of CD.

INTERVENTIONS

The patient received plenty and low level of fibrinogen concentrate during 2 perioperative periods, respectively.

OUTCOMES

Successful clinical outcomes were obtained using different treatment strategies.

LESSONS

In contrast to prior case reports, this case illustrates the feasibility of low dosing of fibrinogen supplements within an asymptomatic patient in a selective operation. Changes in the level of fibrinogen and fibrin degradation product are of great importance for individualized treatment after supplementation.