Fibrinolysis syndrome

Overview

Fibrinolysis syndrome, also known as hyperfibrinolysis, is a rare but serious condition characterized by excessive breakdown of fibrin, a protein that helps form blood clots. This leads to an increased tendency to bleed because the body’s ability to stabilize and maintain blood clots is impaired. Fibrinolysis is a normal physiological process, but when unregulated or excessive, it can result in spontaneous or prolonged bleeding episodes, often complicating trauma, surgery, or certain medical conditions.

Causes

Fibrinolysis syndrome can be classified as either primary or secondary based on its underlying cause:

Primary Hyperfibrinolysis

• Occurs when there is unregulated activation of the fibrinolytic system without preceding clot formation.

• May be congenital (inherited) due to genetic defects in fibrinolysis regulation (very rare).

Secondary Hyperfibrinolysis

• More common and occurs in response to other conditions such as:

• Major trauma or surgery

• Disseminated intravascular coagulation (DIC)

• Liver disease

• Certain cancers, particularly acute promyelocytic leukemia (APL)

• Use of thrombolytic agents (e.g., tPA, streptokinase)

Symptoms

The symptoms of fibrinolysis syndrome are primarily related to abnormal or excessive bleeding. These may include:

• Spontaneous bruising

• Prolonged bleeding after minor injuries

• Bleeding from surgical or wound sites

• Hematuria (blood in urine)

• Gastrointestinal bleeding

• Nosebleeds (epistaxis) or gum bleeding

• Heavy menstrual bleeding in women

• In severe cases, internal bleeding or hemorrhagic shock

Diagnosis

Diagnosis of fibrinolysis syndrome requires a thorough clinical and laboratory evaluation to identify abnormal clot degradation and rule out other bleeding disorders. Diagnostic tests may include:

• Prolonged prothrombin time (PT) and activated partial thromboplastin time (aPTT)

• Low fibrinogen levels

• Elevated D-dimer levels: Indicating excessive fibrin degradation.

• Thromboelastography (TEG) or rotational thromboelastometry (ROTEM): Dynamic tests that assess clot formation and lysis.

• Complete blood count (CBC): To evaluate platelet levels.

• Liver function tests: To check for underlying hepatic dysfunction.

Treatment

Treatment of fibrinolysis syndrome depends on the underlying cause and the severity of bleeding. Therapeutic strategies may include:

• Antifibrinolytic agents: Such as tranexamic acid or aminocaproic acid, which inhibit fibrin degradation and reduce bleeding.

• Replacement therapy: Infusion of fibrinogen concentrate, fresh frozen plasma (FFP), or cryoprecipitate to restore clotting factors.

• Treating the underlying condition: Such as controlling DIC, managing liver disease, or discontinuing thrombolytic medications.

• Supportive care: Including blood transfusions if anemia or significant blood loss is present.

Prognosis

The prognosis for fibrinolysis syndrome depends on its cause, how quickly it is diagnosed, and the response to treatment. When caught early and treated effectively, bleeding can often be controlled, and complications minimized. However, in severe cases—especially when associated with trauma, cancer, or DIC, the condition can be life-threatening. Ongoing monitoring and supportive care are essential to improving outcomes and preventing recurrence.