Hyperfibrinolysis In A Patient With IgG-Paraproteinemia
In patients with various malignancies (prostata, thyreoid, gastric), a hyperfibrinolytic syndrome has been described. We would like to give a report on a 56 year-old male patient who became clinically apparent by his spontaneous bleeding tendencies with large haematoma. Analysis of the coagulation status revealed a primary hyperfibrinolysis characterized by a prolonged TT and PTT, decreased fibrinogen (F I) and a simultaneous increase of FDP, associated with the consumption of F I. There was also a significant fall of plasminogen(Pig) and an alpha2-plasmin-inhibitor α2PI) down to about 10% of the norm. However, a Pig activator as a trigger of hyperfibrinolysis could not be detected in plasma, a malignoma could not be diagnosed. However, a IgG-paraproteinemia and uria associated with a 20% infiltration of bone marrow with plasma cells was assessed. The bleeding tendency was treated successfully with aprotinin (AntagosanR). Under the infusion (1 Mio KIU/d) a normalization of the coagulation status was observed as measured by means of the TT and PTT; simultaneously an increase of F I and the disappearance of FDP was observed. Pig and α2PI also rised but did not reach normal values. Based on these observations an interrelationship between hyperfibrinolysis and paraproteinemia appears to be possible.