Pathophysiology
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 haemorrhage, and
liver surgery. Usually, a fibrinogen level
<1.5 g/dl is considered at risk for
fibrinogen-dependent bleeding, but this
value may change depending on the
different clinical scenarios. DIC is usually
accompanied by low levels of fibrinogen,
as a marker of intravascular coagulation
and consumption of coagulation factors.
The existing DIC scores include
a fibrinogen level <1.0g/l within the
diagnostic score. However, it should be
considered that when DIC occurs in the
setting of sepsis, consumption of
fibrinogen may be relevant even when the
fibrinogen levels are higher: this is related
to the fact that in the early phases of
bloodstream infection and sepsis, the
fibrinogen levels are increased above the
normal levels, as an effect of the acute
phase reaction.
In trauma patients, the main
mechanism leading to low fibrinogen
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