Original Articles

Diagnostic and management practices for inherited fibrinogen disorders: a nationwide survey of Italian Hemophilia Treatment Centers

Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Published: 2 December 2025
10
Views
4
Downloads
0
HTML

Authors

Background: inherited fibrinogen disorders are characterized by a spectrum of quantitative or qualitative fibrinogen deficiency associated with both a hemorrhagic and thrombotic risk.
Methods: a nationwide survey was conducted in 19 Italian Hemophilia Treatment Centers in order to investigate current diagnostic and management practices for inherited fibrinogen disorders (afibrinogenemia, hypofibrinogenemia, and dysfibrinogenemia).
Results: the survey revealed a strong consensus (95% of centers) on the necessity of both functional and antigenic fibrinogen assays for diagnosis, and a preference for fibrinogen concentrate-based treatment (used by >85% of centers). However, significant heterogeneity was observed in critical areas: for hypofibrinogenemia, the definition of a «severe» form varied among centers, and the perceived risk of spontaneous intracranial hemorrhage remained a major point of uncertainty (up to 47% of respondents answered ‘don’t know’ for this risk in hypofibrinogenemia and dysfibrinogenemia). Furthermore, intervention thresholds for major surgical procedures showed a high degree of variability across all three disorders.
Conclusions: the findings highlight areas of consistent practice alongside those requiring further standardization and collaborative research to optimize the care of individuals with these rare bleeding and thrombotic conditions.

 

Downloads

Download data is not yet available.

Citations

1. de Moerloose P, Casini A, Neerman-Arbez M. Congenital fibrinogen disorders: an update. Semin Thromb Hemost 2013;39:585-95. DOI: https://doi.org/10.1055/s-0033-1349222
2. Casini A, Neerman-Arbez M, de Moerloose P. Heterogeneity of congenital afibrinogenemia, from epidemiology to clinical consequences and management. Blood Rev 2021;48:100793. DOI: https://doi.org/10.1016/j.blre.2020.100793
3. Neerman-Arbez M, Casini A. Clinical consequences and molecular bases of low fibrinogenl. Int J Mol Sci 2018;19:192. DOI: https://doi.org/10.3390/ijms19010192
4. Casini A, Moerloose P, Neerman-Arbez M. Clinical, laboratory, and molecular aspects of congenital fibrinogen disorders. Semin Thromb Hemost 2025;51:103-10. DOI: https://doi.org/10.1055/s-0044-1788898
5. Neerman-Arbez M, de Moerloose P, Casini A. Laboratory and genetic investigation of mutations accounting for congenital fibrinogen disorders. Semin Thromb Hemost 2016;42:356-65. DOI: https://doi.org/10.1055/s-0036-1571340
6. Güven B, Can M. Fibrinogen: Structure, abnormalities and laboratory assays. Adv Clin Chem 2024;120:117-43. DOI: https://doi.org/10.1016/bs.acc.2024.03.004
7. Verhovsek M, Moffat KA, Hayward CPM. Laboratory testing for fibrinogen abnormalities. Am J Hematol 2008;83:928-31. DOI: https://doi.org/10.1002/ajh.21293
8. Lak M, Keihani M, Elahi F, et al. Bleeding and thrombosis in 55 patients with inherited afibrinogenaemia. Br J Haematol 1999;107:204-6. DOI: https://doi.org/10.1046/j.1365-2141.1999.01681.x
9. Peyvandi F, Palla R, Menegatti M, et al. Coagulation factor activity and clinical bleeding severity in rare bleeding disorders: results from the European Network of Rare Bleeding Disorders. J Thromb Haemost 2012;10:615-21. DOI: https://doi.org/10.1111/j.1538-7836.2012.04653.x
10. Mohsenian S, Palla R, Menegatti M, et al. Congenital fibrinogen disorders: a retrospective clinical and genetic analysis of the Prospective Rare Bleeding Disorders Database. Blood Adv 2024;8:1392-404. DOI: https://doi.org/10.1182/bloodadvances.2023012186
11. Casini A, de Morerloose P. How I treat dysfibrinogenemia. Blood 2021;138:2021-30. DOI: https://doi.org/10.1182/blood.2020010116
12. Casini A, Brungs T, Lavenu-Bombled C, et al. Genetics, diagnosis and clinical features of congenital hypodysfibrinogenemia: a systematic literature review and report of a novel mutation. J Thromb Haemost 2017;15:876-88. DOI: https://doi.org/10.1111/jth.13655
13. Casini A, Undas A, Palla R, et al. Diagnosis and classification of congenital fibrinogen disorders: communication from the SSC of the ISTH. J Thromb Haemost 2018;16:1887-90. DOI: https://doi.org/10.1111/jth.14216
14. Mumford AD, Ackroyd S, Alikhan R, et al. Guideline for the diagnosis and management of the rare coagulation disorders: a United Kingdom Haemophilia Centre Doctors’ Organization guideline on behalf of the British Committee for Standards in Haematology. Br J Haematol 2014;167:304-26. DOI: https://doi.org/10.1111/bjh.13058
15. Casini A, de Moerloose P, Congenital Fibrinogen Disorders Group. Management of congenital quantitative fibrinogen disorders: a Delphi consensus. Haemophilia 2016;22 898-905. DOI: https://doi.org/10.1111/hae.13061
16. Casini A, Kadir RA, Abdelwahab M, et al. Management of pregnancy and delivery in congenital fibrinogen disorders: communication from the ISTH SSC Subcommittee on Factor XIII and Fibrinogen. J Thromb Haemost 2024;22: 1516-21. DOI: https://doi.org/10.1016/j.jtha.2024.01.008
17. Mohsenian S, Palla R, Menegatti M, et al. Gynecologic and obstetric complications in women with congenital fibrinogen disorders: insights from the Prospective Rare Bleeding Disorders Database. Res Pract Thromb Haemost 2025;9:102960. DOI: https://doi.org/10.1016/j.rpth.2025.102960

How to Cite



1.
Marino R, Linari S, Leotta M, Coppola A, Biasoli C, Mancuso ME, et al. Diagnostic and management practices for inherited fibrinogen disorders: a nationwide survey of Italian Hemophilia Treatment Centers. Bleeding Thromb Vascul Biol [Internet]. 2025 Dec. 2 [cited 2025 Dec. 4];4(3). Available from: https://www.btvb.org/btvb/article/view/372

Most read articles by the same author(s)