Sudan Journal of Medical Sciences Volume 17, Issue no. 2, DOI 10.18502/sjms.v17i2.11462 Production and Hosting by Knowledge E Short Communication Significance of Primary Fibrinogenolysis Bashir Abdrhman Bashir Associate Professor of Hematology, Chairman of Hematology Department, Medical Laboratory Sciences Division, Port Sudan Ahlia College, Port Sudan, Sudan ORCID: Bashir Abdrhman Bashir: https://orcid.org/0000-0002-5089-9531 Dear editor, Primary fibrinogenolysis is a circumstance where the fibrinogen is enzymatically decom- posed due to plasmin activity. This process indicates that fibrinogen is pathologically degraded by plasmin. Primary fibrinogenolysis in its pure form is rare. However, it can occur if dynamic plasmin is excessively released intravenously once the clotting pathway is malfunctioning. Shock, trauma, surgical interventions, acute leukemia, heatstroke, and advanced liver diseases have all been linked to primary fibrinogenolysis. It can emerge in patients experiencing breast cancer, lung cancer, prostate cancer, and renal cell carcinoma. Many plasminogen activators are released into the bloodstream beyond the inhibitors’ capability. They may be produced by bodily reserves (mostly endothelial cells) [1, 2]. In this correspondence, we will explore the hemostatic alterations that have been reported and whether they are relevant to primary fibrinogenolysis. Substantial bleeding is mediated by fibrinogen depletion (split by plasmin) and the release of fibrin split products from fibrinogen [1]. Patients generally do not experience severe bleeding but are at substantial risk for hemorrhage resulting from hypofibrino- genemia. Pronounced thrombocytopenia is expected to raise suspicions of dissemi- nated intravascular coagulation (DIC) [2]. Prothrombin time and partial thromboplastin time are almost always both prolonged. Platelet count is normal with an absence of microcirculatory thrombosis. One of the essential laboratory tools to discriminate between primary fibrinogenolysis and DIC is platelet count, which stays normal (>150 × 109/l) in primary fibrinogenolysis while reduced in DIC. Secondly, antithrombin concentration is low in DIC, but normal in primary fibrinogenolysis. Thirdly, euglobulin clot lysis time will be markedly reduced in primary fibrinogenolysis while normal or slightly shortened in DIC. Finally, the absence of a high concentration of D-dimer in primary fibrinogenolysis versus its elevated concentration in DIC [1]. Once active bleeding develops, it is tough to distinguish between the two How to cite this article: Bashir Abdrhman Bashir (2022) “Significance of Primary Fibrinogenolysis,” Sudan Journal of Medical Sciences, vol. 17, no. 2, pp. 284–286. DOI 10.18502/sjms.v17i2.11462 Page 284 Corresponding Author: Bashir Abdrhman Bashir; email: bashirbashir17@hotmail.com Received 19 October 2021 Accepted 29 May 2022 Published 30 June 2022 Production and Hosting by Knowledge E Bashir Abdrhman Bashir. This article is distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use and redistribution provided that the original author and source are credited. Editor-in-Chief: Prof. Mohammad A. M. Ibnouf http://www.knowledgee.com mailto:bashirbashir17@hotmail.com https://creativecommons.org/licenses/by/4.0/ https://creativecommons.org/licenses/by/4.0/ Sudan Journal of Medical Sciences Bashir Abdrhman Bashir entities since fibrin is obtained as an action of thrombin activation and the lysis of fibrin produces D-dimers [3]. The best approach in patients with primary fibrinogenolysis secondary to malignant disease is often an aggressive treatment of the underlying malignant condition. A study by Kulić et al. described bleeding as a presenting sign of primary fibrinogenolysis in a 64-year-old patient with prostatic cancer [4]. Furthermore, a study performed by Li et al. reported significant gingival bleeding as a presenting finding of primary fibrinogenolysis [2]. Crissman et al. highlighted an amniotic fluid embolism due to obstetric abnormalities in a 29-year-old woman diagnosed with primary fibrinogenolysis rather than DIC [5]. In contrast to DIC, anti-fibrinolytic medications such as aminocaproic acid or Tranex- amic acid are favored remedies for primary fibrinogenolysis [3]. Transfusion support with cryoprecipitate can also be provided for severe hypofibrinogenemia. If DIC has developed, anti-fibrinolytic agents without systemic anticoagulation (like heparin) are contraindicated due to the potential risk of increased microvascular thrombosis [1]. Cau- tion should be exercised to balance chemotherapy-related bone marrow suppression with bleeding complications due to fibrinogenolysis. In conclusion, the significantly reduced fibrinogen and increased fibrin/fibrinogen split products (FSP) and D-dimer levels are diagnostically significant. Coagulopathy should always be taken into account in diagnostic practice. With the rising frequency of cancer, primary fibrinogenolysis secondary to some malignancies may likely emerge in clinical studies. Finally, precise diagnosis is critical in patients with primary fibrinogenolysis and clinical presentation for perfect management. References [1] Tasneem, T. (2009). Primary fibrinogenolysis. Esculapio, vol. 5, no. 3, p. 1. [2] Li, S. (2011). Gingival bleeding as a presenting sign of primary fibrinogenolysis. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology, vol. 112, no. 1, p. 3. [3] Favresse, J., Lippi, G., Roy, P., et al. (2018). D-dimer: Preanalytical, analytical, postanalytical variables, and clinical applications. Critical Reviews in Clinical Laboratory Sciences, vol. 55, no. 8, pp. 548–577. [4] Kulić, A., Cvetković, Z., and Libek, V. (2016). Primary hyperfibrinolysis as the presenting sign of prostate cancer: A case report. Vojnosanitetski Pregled, vol. 73, no. 9, pp. 877–880. DOI 10.18502/sjms.v17i2.11462 Page 285 Sudan Journal of Medical Sciences Bashir Abdrhman Bashir [5] Crissman, H. P., Loder, C., Pancaro, C., et al. (2020). Case report of amniotic fluid embolism coagulopathy following abortion; use of viscoelastic point-of-care analysis. BMC Pregnancy Childbirth, vol. 20, p. 9. DOI 10.18502/sjms.v17i2.11462 Page 286 Dear editor, References