Fibrinogen deficiency in a dog - a case report

Abstract

BackgroundAmong coagulation disorders, primary fibrinogen deficiency is very rare in dogs. It is divided into hypofibrinogenemia, afibrinogenemia and dysfibrinogenemia. Afibrinogenemia has been described in three dogs. There are, however, no published case reports of primary hypofibrinogenemia in dogs.Case presentationA 1.5 year-old male German Pointer dog was evaluated for a locked-jaw syndrome associated with eye protrusion which appeared after a minor head trauma. Three months before the trauma, a persistent increase in coagulation times was detected by the referring veterinarian after a strong suspicion of snake envenomation. Apart for the primary complaint, physical examination was normal. A complete hemostatic profile revealed a moderately increased prothrombin time, activated partial thromboplastin times and a dramatically decreased fibrinogen concentration (0.34 g/L, reference interval [1.3–4.8 g/L]). Platelet count, plasma D-dimers and antithrombin, were all within the reference intervals and not consistent with a disseminated intravascular coagulation. Other possible causes of hypofibrinogenemia such as chronic hemorrhage and liver failure were excluded by laboratory work-up and imaging studies. Finally, antifibrinogen circulating anticoagulants were excluded using a dilution of citrated plasma from the pooled plasma of healthy dogs. These results supported a diagnosis of congenital fibrinogen deficiency and secondary retrobulbar hematoma and/or cellulitis. The dog’s condition improved rapidly after symptomatic treatment with corticosteroids and antibiotics. At the 1 year follow-up, the dog was clinically normal but a persistent hypofibrinogenemia (≤ 0.8 g/L) remained.ConclusionsVarious clinical presentations may occur in canine primary hypofibrinogenemia which should be included in the list of coagulation disorders. Diagnosis should include fibrinogen determination by coagulometric and non-coagulometric methods to differentiate from dysfibrinogenemia. There is no specific treatment but care should be taken to prevent bleeding and trauma. Emergency management of bleeding episodes with cryoprecipitate is the treatment of choice.

Investigation of pathological haemorrhage in Maine Coon cats

“…In human and veterinary medicine, three congenital fibrinogen abnormalities have been described: afibrinogenaemia (absence of fibrinogen), hypofibrinogenaemia (quantitative deficiency) and dysfibrinogenaemia (qualitative deficiency) 33 34. There have been several reports of fibrinogen deficiency in dogs 35–38…”

A review of hyperfibrinolysis in cats and dogs

“…, Jolivet et al . ). Deficiency of the antifibrinolytic serpins alpha 2‐antiplasmin and PAI‐1 results in disinhibition of the fibrinolytic system and primary hyperfibrinolysis (Kolev & Longstaff , Franchini & Mannucci ).…”

“…Haemophilia A and B occur in both cats and dogs (Cotter et al 1978, Brooks 1999, Barr & McMichael 2012. Reports of congenital FXIII deficiency and fibrinogen disorders in animals are extremely rare, and alpha 2-antiplasmin and PAI-1 deficiencies have not been reported (Kammermann et al 1971, Cotter et al 1978, Wilkerson et al 2005, Chambers 2013, Kong et al 2014, Jolivet et al 2017. Deficiency of the antifibrinolytic serpins alpha 2-antiplasmin and PAI-1 results in disinhibition of the fibrinolytic system and primary hyperfibrinolysis (Kolev & Longstaff 2016, Franchini & Mannucci 2018.…”

Comparison of the prothrombin time‐derived and Clauss assays for the measurement of plasma fibrinogen in hospitalized dogs

“…Hyperfibrinolysis contributes to life‐threatening canine bleeding disorders, including consumptive coagulopathies of Angiostrongylus vasorum , 1 heatstroke, 2 and neoplasia associated disseminated intravascular coagulopathy 3 . Accelerated fibrinogen consumption can produce hypofibrinogenemia, which could indicate a poor prognosis 2 and the need for fresh frozen plasma 3 or cryoprecipitate transfusions 4 . Elevated fibrinogen is also a valuable indicator of inflammation 5 and has been linked to the risk of venous thromboembolism in people 6 .…”