摘要
Congenital dysfibrinogenemia (CD) is a qualitative congenital fibrinogen (Fbg) disorder characterized by normal antigen levels of dysfunctional Fbg. A 41-year-old Japanese woman visited the emergent room of our hospital due to acute and severe abdominal pain. Catheterization of the full bladder released her abdominal pain. Magnetic resonance imaging showed a huge pelvic mass, suggesting an intra-mural giant myoma. Before the removal operation of myoma, screening tests showed no abnormalities, including prothrombin time and activated partial thromboplastin time. However, Fbg level was not determined. The patient wanted to receive early surgical treatment, and an abdominal hysterectomy was performed as usual and the intra-operative blood loss was 100 g (ml). However, we found subcutaneous and pelvic hematomas, although active bleeding was not recognized on an emergent computed tomography examination. At that time, we noticed a low level of plasma Fbg (47 mg/dl). We performed a re-laparotomy to remove hematomas. All ligated blood vessels were re-ligated, and oozing points were vaporized. Around the re-operation, six units of fresh frozen plasma and twelve units of red blood cell suspension were transfused. The clinical course after the 2<sup>nd</sup> operation was uneventful except for the low level of Fbg. An additional study showed that the value of the Fbg activity and antigen was dissociated, and the patient was diagnosed CD with <span style="white-space:nowrap;">γ</span>275 Arg to His (CGC to CAC) mutation.
Congenital dysfibrinogenemia (CD) is a qualitative congenital fibrinogen (Fbg) disorder characterized by normal antigen levels of dysfunctional Fbg. A 41-year-old Japanese woman visited the emergent room of our hospital due to acute and severe abdominal pain. Catheterization of the full bladder released her abdominal pain. Magnetic resonance imaging showed a huge pelvic mass, suggesting an intra-mural giant myoma. Before the removal operation of myoma, screening tests showed no abnormalities, including prothrombin time and activated partial thromboplastin time. However, Fbg level was not determined. The patient wanted to receive early surgical treatment, and an abdominal hysterectomy was performed as usual and the intra-operative blood loss was 100 g (ml). However, we found subcutaneous and pelvic hematomas, although active bleeding was not recognized on an emergent computed tomography examination. At that time, we noticed a low level of plasma Fbg (47 mg/dl). We performed a re-laparotomy to remove hematomas. All ligated blood vessels were re-ligated, and oozing points were vaporized. Around the re-operation, six units of fresh frozen plasma and twelve units of red blood cell suspension were transfused. The clinical course after the 2<sup>nd</sup> operation was uneventful except for the low level of Fbg. An additional study showed that the value of the Fbg activity and antigen was dissociated, and the patient was diagnosed CD with <span style="white-space:nowrap;">γ</span>275 Arg to His (CGC to CAC) mutation.
作者
Kenji Niwa
Kentaro Nagata
Takefumi Nakagami
Ryuichiro Shimaoka
Kentaro Niwa
Motoki Takenaka
Takuji Tanaka
Nobuo Okumura
Kenji Niwa;Kentaro Nagata;Takefumi Nakagami;Ryuichiro Shimaoka;Kentaro Niwa;Motoki Takenaka;Takuji Tanaka;Nobuo Okumura(Department of Obstetrics & Gynecology, Gujo City Hospital, Gujo, Japan;Section of Laboratory Medicine and Obstetrics & Gynecology, Gujo City Hospital, Gujo, Japan;Department of Obstetrics & Gynecology, Gifu University School of Medicine, Gifu, Japan;Department of Obstetrics & Gynecology, University of Fukui Hospital, Fukui Prefecture, Japan;Department of Diagnostic Pathology & Research Center of Diagnostic Pathology, Gifu Municipal Hospital, Gifu, Japan;Department of Clinical Laboratory Sciences, School of Health Sciences, Shinshu University, Matsumoto, Japan)
