3. Disorders of fibrinolysis

Question 1

What are the 2 types of fibrinolysis disorders?

Answer 1

1. Hyperfibrinolysis

2. Hypofibrinogenemia

Question 2

Definition of hyperfibrinolysis

Answer 2

Pathological fibrinolysis, which leads to bleeding

Question 3

Etiology of hyperfibrinolysis

Answer 3

1. Disseminated intravascular coagulation (secondary to liver dysfunction, sepsis, etc.)
2. Peripartum complications
3. Treatment with fibrinolytics
4. Surgery in tPA-rich organs such as the prostate and uterus
5. Prostate carcinoma (paraneoplastic)

Question 4

Pathophysiology of hyperfibrinolysis

Answer 4

Excessive plasmin activity → increased fibrin degradation → thrombus instability and dissolution shortly after formation

Question 5

Definition of hypofibrinogenemia

Answer 5

A disorder characterized by low plasma fibrinogen levels

Question 6

Etiology of hypofibrinogenemia

Answer 6

1. Congenital: mutation of fibrinogen genes (FGA, FGB, FGG) on chromosome 4
2. Acquired: associated with liver failure, disseminated intravascular coagulation, liver transplantation, massive blood transfusion, hemodilution, consumption of clotting factors

Question 7

Pathophysiology of hypofibrinogenemia

Answer 7

1. Congenital: mutation → lack of functional fibrinogen glycoprotein → ↓ production of fibrinogen → hemorrhagic diathesis
2. Acquired: ↓ fibrinogen concentration (various causes) → hemorrhagic diathesis

Question 8

Symptoms and findings in hypofibrinogenemia

Answer 8

1. Epistaxis
2. Gastrointestinal hemorrhage
3. Gingival bleeding