Severe haemorrhagic diathesis due to acquired hypofibrinogenemia in a patient with early T-cell precursor acute lymphoblastic leukaemia/lymphoma: a case report
The most frequent haematological malignancy associated with acquired hypo/dysfibrinogenemia is multiple myeloma. We present an unusual case of severe haemorrhagic diathesis due to acquired hypofibrinogenemia in a patient with early T-cell precursor acute lymphoblastic leukaemia/lymphoma (ETP-ALL/LBL...
| Main Authors: | , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Frontiers Media S.A.
2024-01-01
|
| Series: | Frontiers in Cardiovascular Medicine |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fcvm.2023.1335296/full |
| _version_ | 1827387685488033792 |
|---|---|
| author | Luca Spiezia Marcello Riva Carmela Gurrieri Elena Campello Paolo Simioni |
| author_facet | Luca Spiezia Marcello Riva Carmela Gurrieri Elena Campello Paolo Simioni |
| author_sort | Luca Spiezia |
| collection | DOAJ |
| description | The most frequent haematological malignancy associated with acquired hypo/dysfibrinogenemia is multiple myeloma. We present an unusual case of severe haemorrhagic diathesis due to acquired hypofibrinogenemia in a patient with early T-cell precursor acute lymphoblastic leukaemia/lymphoma (ETP-ALL/LBL). A 57-year-old male was admitted to the General Internal Medicine Department of Padova University Hospital for acute massive haematomas of the left lower extremity associated with macrohaematuria. Coagulation tests showed prolonged prothrombin time, activated partial thromboplastin time and thrombin time due to isolated severe hypofibrinogenemia (antigen 0.70 g/L and activity 26%). The radiological workup showed a bulky lesion located in the anterior mediastinum, and a biopsy led to the diagnosis of ETP-ALL/LBL. Fibrinogen replacement therapy failed to correct the bleeding diathesis and we were able to exclude other frequent causes of acquired hypofibrinogenemia (i.e., liver dysfunction, fibrinogen-specific antibody or drug toxicity); therefore, we hypothesised that hypofibrinogenemia might stem either from enhanced removal of fibrinogen from the circulation or consumptive coagulopathy. Notably, only after initiating a specific chemotherapy treatment did the patient start showing improvement in bleeding symptoms and achieve normal fibrinogen levels. |
| first_indexed | 2024-03-08T16:06:48Z |
| format | Article |
| id | doaj.art-d3919bd51c1841b78ea0e57038374679 |
| institution | Directory Open Access Journal |
| issn | 2297-055X |
| language | English |
| last_indexed | 2024-03-08T16:06:48Z |
| publishDate | 2024-01-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Cardiovascular Medicine |
| spelling | doaj.art-d3919bd51c1841b78ea0e570383746792024-01-08T05:40:46ZengFrontiers Media S.A.Frontiers in Cardiovascular Medicine2297-055X2024-01-011010.3389/fcvm.2023.13352961335296Severe haemorrhagic diathesis due to acquired hypofibrinogenemia in a patient with early T-cell precursor acute lymphoblastic leukaemia/lymphoma: a case reportLuca Spiezia0Marcello Riva1Carmela Gurrieri2Elena Campello3Paolo Simioni4General Internal Medicine & Thrombotic and Haemorrhagic Diseases Unit, Department of Medicine, Padova University School of Medicine, Padova, ItalyHaematology and Clinical Immunology Unit, Department of Medicine, Padova University School of Medicine, Padova, ItalyHaematology and Clinical Immunology Unit, Department of Medicine, Padova University School of Medicine, Padova, ItalyHaematology and Clinical Immunology Unit, Department of Medicine, Padova University School of Medicine, Padova, ItalyGeneral Internal Medicine & Thrombotic and Haemorrhagic Diseases Unit, Department of Medicine, Padova University School of Medicine, Padova, ItalyThe most frequent haematological malignancy associated with acquired hypo/dysfibrinogenemia is multiple myeloma. We present an unusual case of severe haemorrhagic diathesis due to acquired hypofibrinogenemia in a patient with early T-cell precursor acute lymphoblastic leukaemia/lymphoma (ETP-ALL/LBL). A 57-year-old male was admitted to the General Internal Medicine Department of Padova University Hospital for acute massive haematomas of the left lower extremity associated with macrohaematuria. Coagulation tests showed prolonged prothrombin time, activated partial thromboplastin time and thrombin time due to isolated severe hypofibrinogenemia (antigen 0.70 g/L and activity 26%). The radiological workup showed a bulky lesion located in the anterior mediastinum, and a biopsy led to the diagnosis of ETP-ALL/LBL. Fibrinogen replacement therapy failed to correct the bleeding diathesis and we were able to exclude other frequent causes of acquired hypofibrinogenemia (i.e., liver dysfunction, fibrinogen-specific antibody or drug toxicity); therefore, we hypothesised that hypofibrinogenemia might stem either from enhanced removal of fibrinogen from the circulation or consumptive coagulopathy. Notably, only after initiating a specific chemotherapy treatment did the patient start showing improvement in bleeding symptoms and achieve normal fibrinogen levels.https://www.frontiersin.org/articles/10.3389/fcvm.2023.1335296/fullhaemorrhagic diathesisacquired hypofibrinogenemiaearly T-cell precursor acute lymphoblastic leukaemia/lymphomacase reportconsumptive coagulopathy |
| spellingShingle | Luca Spiezia Marcello Riva Carmela Gurrieri Elena Campello Paolo Simioni Severe haemorrhagic diathesis due to acquired hypofibrinogenemia in a patient with early T-cell precursor acute lymphoblastic leukaemia/lymphoma: a case report Frontiers in Cardiovascular Medicine haemorrhagic diathesis acquired hypofibrinogenemia early T-cell precursor acute lymphoblastic leukaemia/lymphoma case report consumptive coagulopathy |
| title | Severe haemorrhagic diathesis due to acquired hypofibrinogenemia in a patient with early T-cell precursor acute lymphoblastic leukaemia/lymphoma: a case report |
| title_full | Severe haemorrhagic diathesis due to acquired hypofibrinogenemia in a patient with early T-cell precursor acute lymphoblastic leukaemia/lymphoma: a case report |
| title_fullStr | Severe haemorrhagic diathesis due to acquired hypofibrinogenemia in a patient with early T-cell precursor acute lymphoblastic leukaemia/lymphoma: a case report |
| title_full_unstemmed | Severe haemorrhagic diathesis due to acquired hypofibrinogenemia in a patient with early T-cell precursor acute lymphoblastic leukaemia/lymphoma: a case report |
| title_short | Severe haemorrhagic diathesis due to acquired hypofibrinogenemia in a patient with early T-cell precursor acute lymphoblastic leukaemia/lymphoma: a case report |
| title_sort | severe haemorrhagic diathesis due to acquired hypofibrinogenemia in a patient with early t cell precursor acute lymphoblastic leukaemia lymphoma a case report |
| topic | haemorrhagic diathesis acquired hypofibrinogenemia early T-cell precursor acute lymphoblastic leukaemia/lymphoma case report consumptive coagulopathy |
| url | https://www.frontiersin.org/articles/10.3389/fcvm.2023.1335296/full |
| work_keys_str_mv | AT lucaspiezia severehaemorrhagicdiathesisduetoacquiredhypofibrinogenemiainapatientwithearlytcellprecursoracutelymphoblasticleukaemialymphomaacasereport AT marcelloriva severehaemorrhagicdiathesisduetoacquiredhypofibrinogenemiainapatientwithearlytcellprecursoracutelymphoblasticleukaemialymphomaacasereport AT carmelagurrieri severehaemorrhagicdiathesisduetoacquiredhypofibrinogenemiainapatientwithearlytcellprecursoracutelymphoblasticleukaemialymphomaacasereport AT elenacampello severehaemorrhagicdiathesisduetoacquiredhypofibrinogenemiainapatientwithearlytcellprecursoracutelymphoblasticleukaemialymphomaacasereport AT paolosimioni severehaemorrhagicdiathesisduetoacquiredhypofibrinogenemiainapatientwithearlytcellprecursoracutelymphoblasticleukaemialymphomaacasereport |