McRoyan D K, McRoyan C J, Kitay D Z, Liu P I
Ann Clin Lab Sci. 1986 Jan-Feb;16(1):52-7.
This case of a 31-year-old white woman presenting at 32 weeks gestation with vaginal bleeding supports a possible association between constitutional hypofibrinogenemia and third trimester hemorrhage. Clot based fibrinogen assays were persistently low for the third trimester (patient: 102 to 155 mg per dl; normal range: 400 to 650 mg per dl) and at follow-up, ten months post-partum (patient: 90 mg per dl; normal range 180 to 436 mg per dl); an immunologic fibrinogen level was comparable. The patient gave an unremarkable bleeding history. Of 11 previously reported pregnancies in five hypofibrinogenemic patients, six terminated in placental abruption during the third trimester, two others were complicated by significant post-partum hemorrhage, and one by spontaneous abortion. This case report emphasizes that low functional levels of fibrinogen are potentially disruptive to the integrity of the uteroplacental interface. The pregnant state unmasks and amplifies an otherwise silent to mild hemostatic disorder.
该病例为一名31岁白人女性，妊娠32周时出现阴道出血，提示先天性低纤维蛋白原血症与孕晚期出血之间可能存在关联。基于凝血块的纤维蛋白原检测在孕晚期持续偏低（患者：每分升102至155毫克；正常范围：每分升400至650毫克），产后10个月随访时仍低（患者：每分升90毫克；正常范围每分升180至436毫克）；免疫纤维蛋白原水平相当。患者既往出血史无异常。在先前报道的5例低纤维蛋白原血症患者的11次妊娠中，6例在孕晚期因胎盘早剥而终止妊娠，另外2例并发严重产后出血，1例自然流产。本病例报告强调，纤维蛋白原功能水平低可能会破坏子宫胎盘界面的完整性。妊娠状态会暴露并放大原本无症状或症状轻微的止血障碍。
