HHE Sponsored supplement: Managing perioperative bleed - Page 9

procedures, trauma and delivery. Clinical manifestations of dysfibrinogenemia are very heterogeneous, ranging from absence of clinically relevant symptoms to major bleeding, and even thrombosis. The evidence of thromboembolic complications in patients with fibrinogen deficiency (in around 30% of the subjects 5 ) is difficult to explain, given the pro-coagulant properties of fibrinogen. The main interpretation is that the low levels of fibrinogen may promote a weak clot, more susceptible to the lytic effects of plasmin. This could result in a partial or total clot breakdown, with embolisation of clot parts. More common are the acquired conditions, which may derive from liver disease, 9 HHE 2018 | hospitalhealthcare.com disseminated intravascular coagulation (DIC), thrombolytic therapy, haemodilution or consumption. Basically, acquired hypofibrinogenemia results from a reduced synthesis (liver disease), excessive activation of the haemostatic system with consumption of the substrates (disseminated intravascular coagulation), severe haemodilution (heart surgery with cardiopulmonary bypass especially in newborns and infants; resuscitation of trauma patients), or excessive fibrinogen breakdown (hyperfibrinolysis). Low levels of fibrinogen may lead to an increased risk of bleeding. The clinical scenarios where this condition is more common include sepsis with DIC, cardiac surgery with cardiopulmonary bypass, trauma, post-partum