Chambers Gregory
California Animal Hospital Veterinary Specialty Group, Los Angeles, CA, USA.
J Am Anim Hosp Assoc. 2013 Jan-Feb;49(1):70-4. doi: 10.5326/JAAHA-MS-5837. Epub 2012 Nov 12.
This report discusses the diagnosis and treatment of afibrinogenemia in a Chihuahua. Prolongations of prothrombin time (PT), activated partial thromboplastin time (aPTT), and thrombin clotting time (TCT) together with fibrinogen assay results of either no or trace amounts of fibrinogen support a diagnosis of afibrinogenemia. Differential diagnoses include common coagulopathies, liver failure, and disseminated intravascular coagulation (DIC). Either aggressive cryoprecipitate or plasma transfusions are required to treat afibrinogenemia. The current guidelines for treatment of coagulopathies include plasma transfusions (either 15-30 mL/kg or until both PT and aPTT are normalized). This report describes a case in which bleeding persisted 2 days after standard plasma transfusion levels were administered and PT and aPTT levels had normalized. In this case, the bleeding was stabilized for up to 2 mo after administering > 54 mL/kg plasma. In human medicine, either cryoprecipitate or fibrinogen concentrate is used to increase blood fibrinogen levels to 100 mg/dL for minor bleeding and 200 mg/dL for major bleeding. Further studies are needed; however, the author of this report suggests that aggressive transfusions and monitoring are needed in veterinary afibrinogenemia cases.
本报告讨论了一只吉娃娃犬无纤维蛋白原血症的诊断和治疗。凝血酶原时间（PT）、活化部分凝血活酶时间（aPTT）和凝血酶凝结时间（TCT）延长，以及纤维蛋白原检测结果显示无纤维蛋白原或仅有微量纤维蛋白原，支持无纤维蛋白原血症的诊断。鉴别诊断包括常见的凝血障碍、肝功能衰竭和弥散性血管内凝血（DIC）。治疗无纤维蛋白原血症需要积极输注冷沉淀或血浆。目前凝血障碍的治疗指南包括输注血浆（15 - 30 mL/kg或直至PT和aPTT均恢复正常）。本报告描述了一个病例，在给予标准血浆输注量且PT和aPTT水平恢复正常后，出血仍持续了2天。在这个病例中，输注超过54 mL/kg血浆后，出血稳定了长达2个月。在人类医学中，对于 minor 出血，使用冷沉淀或纤维蛋白原浓缩物将血液纤维蛋白原水平提高到100 mg/dL，对于 major 出血则提高到200 mg/dL。然而，还需要进一步研究；本报告的作者建议，在兽医无纤维蛋白原血症病例中，需要积极输血和监测。
