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Casini A, Abdul Kadir R, Abdelwahab M, Manco-Johnson MJ, Raut S, Ross C, de Moerloose P, Santoro C, Acharya S. Management of pregnancy and delivery in congenital fibrinogen disorders: communication from the ISTH SSC Subcommittee on Factor XIII and Fibrinogen. J Thromb Haemost 2024; 22:1516-1521. [PMID: 38266678 DOI: 10.1016/j.jtha.2024.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 01/04/2024] [Accepted: 01/07/2024] [Indexed: 01/26/2024]
Abstract
Congenital fibrinogen disorders (CFDs) are a heterogeneous group of rare congenital quantitative and/or qualitative fibrinogen deficiencies. The spectrum of molecular anomalies is broad, leading to several subtypes of fibrinogen disorders (ie, afibrinogenemia, hypofibrinogenemia, dysfibrinogenemia, and hypodysfibrinogenemia). Pregnancy in women with CFDs is a high-risk clinical situation, with an increased tendency for miscarriages, bleeding, and thrombosis. Even though it is well established that management of such pregnancies requires a multidisciplinary approach involving specialists (hematologists and maternal/fetal medicine experts with expertise in the management of inherited bleeding disorders), specific guidelines are lacking. In this International Society on Thrombosis and Haemostasis (ISTH) Scientific and Standardization Committee communication, we aim to propose an expert consensus opinion with literature evidence where available on the strategy for management of pregnancy, delivery, and puerperium in CFDs.
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Affiliation(s)
- Alessandro Casini
- Division of Angiology and Hemostasis, University Hospitals of Geneva, Geneva, Switzerland.
| | - Rezan Abdul Kadir
- Department of Obstetrics and Gynaecology, Katharine Dormandy Haemophilia and Thrombosis Centre, The Royal Free London National Health Service Foundation Trust, London, UK; Institute for Women's Health, University College London, London, UK
| | - Magy Abdelwahab
- Pediatric Hematology Department, Cairo University Pediatric Hospital, Social and Preventive Medicine, Kasralainy Hospital, Cairo, Egypt
| | - Marilyn J Manco-Johnson
- Department of Pediatrics, Hemophilia and Thrombosis Center, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Sanj Raut
- Haemostasias Section, Biotherapeutics Group, National Institute for Biological Standards and Control, Potters Bar, UK
| | - Cecil Ross
- Department Medicine and Hematology, St. John's Medical College Hospital, Bangalore, Karnataka, India
| | | | - Cristina Santoro
- Hematology, Hemophilia and Thrombosis Center, University Hospital Policlinico Umberto I, Rome, Italy
| | - Suchitra Acharya
- Hemostasis and Thrombosis Center, Northwell Health, New Hyde Park, New York, USA
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Trossaert M, Chamouard V, Biron-Andreani C, Casini A, De Mazancourt P, De Raucourt E, Drillaud N, Frotscher B, Guillet B, Lebreton A, Roussel-Robert V, Rugeri L, Dargaud Y. Management of rare inherited bleeding disorders: Proposals of the French Reference Centre on Haemophilia and Rare Coagulation Disorders. Eur J Haematol 2023; 110:584-601. [PMID: 36748278 DOI: 10.1111/ejh.13941] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 01/25/2023] [Accepted: 01/31/2023] [Indexed: 02/08/2023]
Abstract
INTRODUCTION The rare coagulation disorders may present significant difficulties in diagnosis and management. In addition, considerable inter-individual variation in bleeding phenotype is observed amongst affected individuals, making the bleeding risk difficult to assess in affected individuals. The last international recommendations on rare inherited bleeding disorders (RIBDs) were published by the United Kingdom Haemophilia Centre Doctors' Organisation in 2014. Since then, new drugs have been marketed, news studies on surgery management in patients with RIBD have been published, and new orphan diseases have been described. AIM Therefore, the two main objectives of this review, based on the recent recommendations published by the French Reference Centre on Haemophilia and Rare Bleeding Disorders, are: (i) to briefly describe RIBD (clinical presentation and diagnostic work-up) to help physicians in patient screening for the early detection of such disorders; and (ii) to focus on the current management of acute haemorrhages and long term prophylaxis, surgical interventions, and pregnancy/delivery in patients with RIBD.
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Affiliation(s)
- Marc Trossaert
- Haemophilia Treatment Centre, University Hospital of Nantes and French Reference Centre on Haemophilia, Nantes, France
| | - Valerie Chamouard
- Haemophilia Treatment Centre, University Hospital of Lyon and French Reference Centre on Haemophilia, Lyon, France
| | | | - Alessandro Casini
- Angiology and Haemostasis Division, Faculty of Medicine, University Hospitals of Geneva, Geneva, Switzerland
| | - Philippe De Mazancourt
- Laboratory of Biochemistry and Molecular Genetics, Hospital Ambroise Paré-GHU APHP, Université Paris-Saclay, Boulogne-Billancourt, France
| | | | - Nicolas Drillaud
- Haemophilia Treatment Centre, University Hospital of Nantes and French Reference Centre on Haemophilia, Nantes, France
| | - Birgit Frotscher
- Haemophilia Treatment Centre, University Hospital of Nancy, Nancy, France
| | - Benoit Guillet
- Haemophilia Treatment Centre, University Hospital of Rennes, Rennes, France
| | - Aurelien Lebreton
- Haemophilia Treatment Centre, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
| | | | - Lucia Rugeri
- Haemophilia Treatment Centre, University Hospital of Lyon and French Reference Centre on Haemophilia, Lyon, France
| | - Yesim Dargaud
- Haemophilia Treatment Centre, University Hospital of Lyon and French Reference Centre on Haemophilia, Lyon, France
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Casini A, Neerman-Arbez M, de Moerloose P. Heterogeneity of congenital afibrinogenemia, from epidemiology to clinical consequences and management. Blood Rev 2020; 48:100793. [PMID: 33419567 DOI: 10.1016/j.blre.2020.100793] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 11/06/2020] [Accepted: 12/06/2020] [Indexed: 12/17/2022]
Abstract
Fibrinogen is a complex protein playing a major role in coagulation. Congenital afibrinogenemia, characterized by the complete absence of fibrinogen, is associated with major hemostatic defects. Even though the clinical course is unpredictable and can be completely different among patients, severe bleeding is the prominent symptom. Patients are also at increased risk of thrombosis and sometimes suffer from spontaneous spleen rupture, bone cysts and defective wound healing. Due to the relative rarity of afibrinogenemia, there are no evidence-based strategies for helping physicians in care of these patients. Fibrinogen supplementation is the keystone to prevent or treat bleeding events. In addition, fibrinogen, a pleiotropic protein with numerous physiological roles in immunity, angiogenesis and tissue repair, is involved in many diseases. Indeed, depletion of fibrinogen in animal models of infections, tumors and neurological diseases has an effect on the clinical course. The consequences for patients with afibrinogenemia still need to be investigated.
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Affiliation(s)
- Alessandro Casini
- Division of Angiology and Hemostasis, University Hospitals of Geneva, Geneva, Switzerland; Faculty of Medicine, University of Geneva, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland.
| | - Marguerite Neerman-Arbez
- Department of Genetic Medicine and Development, Faculty of Medicine, University of Geneva, 1 Rue Michel Servet, 1211 Geneva, Switzerland.
| | - Philippe de Moerloose
- Faculty of Medicine, University of Geneva, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland.
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Dorgalaleh A, Tabibian S, Hosseini MS, Shams M. Pharmacological management of rare coagulation factor deficiencies besides hemophilia. Expert Rev Hematol 2020; 13:811-834. [PMID: 32667216 DOI: 10.1080/17474086.2020.1796622] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Rare coagulation factor deficiencies are less-known disorders with variable effects on the patient's life. Management of such patients is a challenge due to the paucity of evidence-based data, more so when patients with these rare disorders encounter a more rare, related condition, like inhibitor development or thrombosis. AREA COVERED A comprehensive literature search related to RCFDs and management was performed in PubMed in order to discuss therapeutic options and challenges, prophylaxis, management of minor and major surgeries, obstetric and gynecological complications, inhibitor development, and thrombosis. EXPERT OPINION Although significant changes have occurred in the management of RCFDs in recent years, more evidence-based studies besides expert opinion are needed for optimal management.
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Affiliation(s)
- Akbar Dorgalaleh
- Department of Hematology and Blood Transfusion, School of Allied Medicine, Iran University of Medical Sciences , Tehran, Iran
| | - Shadi Tabibian
- Department of Hematology and Blood Transfusion, School of Allied Medicine, Iran University of Medical Sciences , Tehran, Iran.,Iranian Comprehensive Hemophilia Care Center , Tehran, Iran
| | - Maryam Sadat Hosseini
- Department of Hematology and Blood Transfusion, School of Allied Medicine, Shahid Beheshti University of Medical Sciences , Tehran, Iran
| | - Mahmood Shams
- Department of Medical Laboratory, Faculty of Paramedical Sciences, Babol University of Medical Sciences , Babol, Iran
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Saes JL, Laros‐van Gorkom BAP, Coppens M, Schols SEM. Pregnancy outcome in afibrinogenemia: Are we giving enough fibrinogen concentrate? A case series. Res Pract Thromb Haemost 2020; 4:343-346. [PMID: 32110766 PMCID: PMC7040545 DOI: 10.1002/rth2.12300] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 12/04/2019] [Accepted: 12/05/2019] [Indexed: 12/17/2022] Open
Abstract
Congenital afibrinogenemia is a rare autosomal recessive disorder associated with an increased risk of hemorrhage, thrombosis, and obstetric complications. This case series of 4 pregnancies in 2 related patients seeks to address the key clinical question of the necessary doses of fibrinogen concentrate during pregnancy and puerperium. One pregnancy without the prophylactic use of fibrinogen concentrate resulted in spontaneous abortion. The second pregnancy was complicated by a subchorionic hematoma despite the prophylactic administration of fibrinogen concentrate to maintain the plasma trough levels at ≥0.6 g/L. Labor was complicated by postpartum hemorrhage with a blood loss volume of 1480 cc. Two weeks later, the patient presented with postpartum thrombosis. The other 2 pregnancies were uncomplicated with fibrinogen trough levels ≥1.0 g/L during pregnancy and ≥1.5 g/L during labor. These cases illustrate that during pregnancy, patients may benefit from fibrinogen trough levels ≥1.0 g/L. In addition, the increased risk of postpartum thrombosis with prolonged fibrinogen supplementation warrants personalized postpartum advice that is guided by postpartum blood loss.
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Affiliation(s)
- Joline L. Saes
- Department of HematologyRadboud Universisty Medical CenterNijmegenThe Netherlands
- Hemophilia Treatment Center NijmegenEindhovenThe Netherlands
| | - Britta A. P. Laros‐van Gorkom
- Department of HematologyRadboud Universisty Medical CenterNijmegenThe Netherlands
- Hemophilia Treatment Center NijmegenEindhovenThe Netherlands
| | - Michiel Coppens
- Department of Vascular MedicineAmsterdam Cardiovascular SciencesAmsterdam University Medical CentersUniversity of AmsterdamAmsterdamThe Netherlands
| | - Saskia E. M. Schols
- Department of HematologyRadboud Universisty Medical CenterNijmegenThe Netherlands
- Hemophilia Treatment Center NijmegenEindhovenThe Netherlands
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Casini A, Moerloose P. Fibrinogen concentrates in hereditary fibrinogen disorders: Past, present and future. Haemophilia 2019; 26:25-32. [DOI: 10.1111/hae.13876] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 10/22/2019] [Accepted: 10/22/2019] [Indexed: 12/17/2022]
Affiliation(s)
- Alessandro Casini
- Division of Angiology and Hemostasis Faculty of Medicine Geneva University Hospitals Geneva Switzerland
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Valiton V, Hugon-Rodin J, Fontana P, Neerman-Arbez M, Casini A. Obstetrical and postpartum complications in women with hereditary fibrinogen disorders: A systematic literature review. Haemophilia 2019; 25:747-754. [PMID: 31368232 DOI: 10.1111/hae.13825] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 06/21/2019] [Accepted: 06/26/2019] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Hereditary fibrinogen disorders (HFD) are rare quantitative or qualitative fibrinogen anomalies, including afibrinogenaemia (A), hypofibrinogenaemia (H), dysfibrinogenaemia (D) and hypodysfibrinogenaemia (HD). As fibrinogen plays an essential role in pregnancy, we addressed the issue of obstetrical and postpartum complications in women with HFD. METHODS A systematic literature review, restricted to English manuscripts, was conducted according to the PRISMA guidelines. We searched through the MEDLINE database for English articles, published from January 1985 until November 2018, focusing on pregnancy in A, H, D and HD. A total of 198 articles were identified, 15 articles were added from other sources. Overall, 213 articles were screened and 54 were included in the final analysis. RESULTS A total of 188 pregnancies from 70 women were analysed. About half of pregnancies resulted in miscarriage; more specifically in 15 (42.9%), 36 (46.8%), 27 (42.9%) and 4 (30.8%) of A, H, D and HD patients, respectively. Preterm complications were also frequent (33.5%). Metrorrhagia, mainly in the first trimester, was observed in 21.7% of the pregnancies. Placenta abruption was reported in 5 (14.3%), 4 (5.2%), 5 (7.9%) and 1 (7.7%) of A, H, D and HD, respectively. A total of 24 (12.7%) deliveries were complicated by postpartum thrombotic events (3.2%) or postpartum haemorrhage (9.6%). A fibrinogen replacement therapy was introduced in 30% of pregnancies, as prophylaxis (81.1%) or on demand (18.9%). CONCLUSION These results suggest that women with HFD are at high risk of obstetrical and postpartum complications. Prospective international registries may allow to identify more precisely the incidence of obstetrical and postpartum adverse outcomes and their management.
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Affiliation(s)
- Vivian Valiton
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Justine Hugon-Rodin
- Unité de Gynécologie Endocrinienne, Hôpital Port-Royal, Université Paris Descartes, Equipe EPOPE, Inserm, Paris, France
| | - Pierre Fontana
- Division of angiology and hemostasis, University Hospitals of Geneva, Geneva, Switzerland
| | - Marguerite Neerman-Arbez
- Department of Genetic Medicine and Development, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Alessandro Casini
- Division of angiology and hemostasis, University Hospitals of Geneva, Geneva, Switzerland
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Karimi M, Bordbar M, Aali M, Bazrafshan A, Tavoosi H, Gerdabi J. Successful delivery in an patient with afibrinogenemia after three abortions: A case report and review of the literature. Haemophilia 2018; 24:e63-e66. [DOI: 10.1111/hae.13415] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2017] [Indexed: 12/17/2022]
Affiliation(s)
- M. Karimi
- Hematology Research Center; Shiraz University of Medical Sciences; Shiraz Iran
| | - M. Bordbar
- Hematology Research Center; Shiraz University of Medical Sciences; Shiraz Iran
| | - M. Aali
- Shiraz Hemophilia Comprehensive Center; Dastgheib Hospital; Shiraz University of Medical Sciences; Shiraz Iran
| | - A. Bazrafshan
- Hematology Research Center; Shiraz University of Medical Sciences; Shiraz Iran
| | - H. Tavoosi
- Shiraz Hemophilia Comprehensive Center; Dastgheib Hospital; Shiraz University of Medical Sciences; Shiraz Iran
| | - J. Gerdabi
- Shiraz Comprehensive Coagulation Laboratory; Dastgheib Hospital; Shiraz University of Medical Sciences; Shiraz Iran
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Neerman-Arbez M, Casini A. Clinical Consequences and Molecular Bases of Low Fibrinogen Levels. Int J Mol Sci 2018; 19:E192. [PMID: 29316703 PMCID: PMC5796141 DOI: 10.3390/ijms19010192] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 12/22/2017] [Accepted: 12/22/2017] [Indexed: 12/19/2022] Open
Abstract
The study of inherited fibrinogen disorders, characterized by extensive allelic heterogeneity, allows the association of defined mutations with specific defects providing significant insight into the location of functionally important sites in fibrinogen and fibrin. Since the identification of the first causative mutation for congenital afibrinogenemia, studies have elucidated the underlying molecular pathophysiology of numerous causative mutations leading to fibrinogen deficiency, developed cell-based and animal models to study human fibrinogen disorders, and further explored the clinical consequences of absent, low, or dysfunctional fibrinogen. Since qualitative disorders are addressed by another review in this special issue, this review will focus on quantitative disorders and will discuss their diagnosis, clinical features, molecular bases, and introduce new models to study the phenotypic consequences of fibrinogen deficiency.
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Affiliation(s)
- Marguerite Neerman-Arbez
- Department of Genetic Medicine and Development, Faculty of Medicine, University of Geneva, 1211 Geneva, Switzerland.
| | - Alessandro Casini
- Division of Angiology and Hemostasis, Faculty of Medicine, Geneva University Hospitals, 1211 Geneva, Switzerland.
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