Hyperfibrinogenemia is a pathological condition characterized by an increase in the concentration of fibrinogen in the blood over 4 g/l. In addition to its important role in blood coagulation, fibrinogen is one of the major acute phase proteins. Therefore, any kind of cellular or tissue damage or inflammation is accompanied by an increase in the production of this protein. The cause of hyperfibrinogenemia can be acute infections, injuries, burns, etc. The level of fibrinogen is examined in blood plasma as part of a standard coagulogram. Correction is carried out by treating the underlying disease.
During pregnancy, many body systems undergo significant changes. The blood coagulation system also undergoes changes. Under the influence of an increasing concentration of female sex hormones (estrogens, progesterone), fibrinogen synthesis increases, and other components of hemostasis are activated.
All these processes have a physiological meaning, as they prevent possible blood loss during childbirth, which can be fatal to the fetus. The content of fibrinogen begins to increase from the middle of the first trimester of pregnancy and reaches a maximum by the end of the third trimester (sometimes up to 6 g / l). After childbirth, fibrinogen gradually returns to normal values, so hyperfibrinogenemia during pregnancy does not require any treatment.
In any acute infectious diseases, especially generalized ones (meningococcemia, sepsis), the production of inflammatory mediators and cytokines - interleukins 1 and 6, tumor necrosis factor, etc., occurs to one degree or another. Under their action, acute phase proteins, such as C-reactive protein, complement system proteins and fibrinogen, are synthesized in the liver.
These proteins assist in the functioning of immune system cells (T- and B-lymphocytes, neutrophils): promote cell migration to the focus of inflammation, stimulate phagocytosis, and neutralize free radicals. The concentration of fibrinogen increases during the height of the disease and returns to normal within a few days after recovery. By itself, hyperfibrinogenemia has no clinical signs, and also does not require intervention.
With myocardial infarction, necrosis of a section of the heart muscle occurs, and aseptic inflammation develops. Secreted acute-phase proteins (fibrinogen, CRP) contribute to the binding and removal of endogenous substances that are formed as a result of cell destruction. Hyperfibrinogenemia reaches its maximum by the 5th day from the development of MI and resolves itself by the end of 3 weeks.
fibrin strands
Since female sex hormones in high concentrations directly affect the blood coagulation system, namely, they can cause hypercoagulability, long-term hormonal therapy with oral contraceptives containing estrogens may be accompanied by hyperfibrinogenemia.
Hormonal drugs have a fairly wide range of applications: preventing unwanted pregnancy, treating a number of gynecological and endocrine disorders, combating the complications of severe menopause. The clinical sign of hyperfibrinogenemia while taking these hormonal agents may be thrombosis, most often deep vein thrombosis of the lower extremities.
The growth of a malignant tumor is accompanied by the destruction of surrounding tissues. With intensive cell breakdown, potentially toxic substances (potassium, myoglobin) enter the systemic circulation. Their binding, neutralization and elimination occurs with the participation of fibrinogen and other proteins. The degree of hyperfibrinogenemia is determined by the aggressiveness of the growth of the formation.
There are some diseases and pathological conditions that may be accompanied by hyperfibrinogenemia, however, the mechanism of its development remains unknown. Hyperfibrinogenemia in these diseases has no clinical signs and does not require treatment:
With high values of fibrinogen, it is necessary to consult a general practitioner to find out the cause. First of all, it is clarified whether the patient is taking any medications. If pregnancy is suspected, the doctor asks about the date of the last menstruation and the presence of symptoms that may be an indirect sign of pregnancy - a sharp increase in appetite, nausea in the morning. Additional research methods are assigned:
Fibrinogen study
If the cause of hyperfibrinogenemia was the use of oral contraceptives, in order to avoid the development of thrombosis, it may be necessary to cancel these drugs if the patient has risk factors (overweight, smoking, hereditary thrombophilia). In all other cases, with the exception of pregnancy, treatment of the underlying disease is necessary to correct hyperfibrinogenemia. The following treatments are used:
Patients with MI undergo revascularization surgery, i.e. restoration of blood flow in the coronary arteries - percutaneous transluminal balloon angioplasty followed by stenting. A catheter is inserted through the femoral or radial artery and placed in the affected coronary artery. At the site of stenosis, using high pressure, the atherosclerotic plaque is destroyed, then a stent is placed in this place, expanding the lumen of the vessel.
Patients with multiple lesions of the coronary arteries in several areas will not be effectively stented, so they undergo an open operation - coronary artery bypass grafting. Patients with amyloidosis often require a kidney transplant.
Hyperfibrinogenemia is a sign of the severity of many inflammatory processes and may indicate a poor prognosis. It also acts as a risk factor for venous or arterial thrombosis. Therefore, this laboratory deviation requires further examination for timely diagnosis and treatment of diseases.