Clinical phenotype, fibrinogen supplementation and health-related quality of life in patients with afibrinogenemia

Authors: Casini, A., von, Mackensen S., Santoro, C., Djambas, Khayat C., Belhani, M., Ross, C., Dorgalaleh, A., Naz, A., Unal, E., Abdelwahab, M., Dupuis, Lozeron E., Trillot, N., Susen, S., Peyvandi, F., and de, Moerloose P.

Publication: Blood; January 2021

Affiliations: University of Geneva, Faculty of Medicine, Geneva, Switzerland, Switzerland ; University Medical Centre Hamburg-Eppendorf, Hamburg, Germany; Ematologia, Azienda Ospedaliera Universitaria Policlinico Umberto I, Rome, Italy; Hotel Dieu de France Hospital, Beirut, Lebanon ; Beni Messous University Hospital, Alger, Algeria ; St. John’s Medical College Hospital, Bangalore, India ; Iran University of Medical Sciences, Tehran, Georgia, Iran, Islamic Republic of National Institute Of Blood Disease and Bone marrow Transplantation, Pakistan, Karachi, Pakistan; Erciyes University, Pediatric Hematology Oncology, Kayseri, Turkey ; Cairo University Pediatric Hospital, Cairo, Egypt ; Geneva University Hospitals, Geneva, Switzerland Centre Hospitalier Universitaire de Lille, LILLE, France ; Lille University Hospital, Lille, France ; Université degli Studi di Milano, Milan, Italy ; University Hospital of Geneva, Geneva, Switzerland.

Abstract: Due to its low prevalence, epidemiologic data on afibrinogenemia are limited and none are available on health-related quality of life (HRQoL). We conducted a cross-sectional international study to characterize the clinical features, the fibrinogen supplementation modalities and their impact on HRQoL in patients with afibrinogenemia. A total of 204 patients (119 adults and 85 children) from 25 countries were included. The bleeding phenotype was severe: 68 (33.3%) patients having at least one bleed per month and 48 (23%) a history of cerebral bleeding. About 35% (n=72) of patients were treated with fibrinogen concentrates or cryoprecipitates as prophylaxis, 18.1% (n=37) received more than one injection per week and 16.6% (n=34) were on home treatment. A thrombotic event was reported in venous and/or arterial territories by 37 (18.1%) patients. Thrombosis occurred even in young patients and recurrence was frequent (7.4%). The total HRQoL was lower in children than in adults. Discomfort linked to treatment and limitations to sports and leisure were the main concerns. Women and children were particularly affected in family relationships. In multivariate analyses, younger age, residence in Asia or Africa and a previous thrombotic event were statistically correlated with a worse HRQoL. In conclusion, our study underlines the severe bleeding and thrombotic phenotype and their impact on HRQoL in afibrinogenemia. The optimal strategy for fibrinogen supplementation needs to be determined.