Steroid-associated hypofibrinogenemia: an overlooked risk in graft-versus-host disease management after allogeneic hematopoietic stem cell transplantation.
Fahir Ozturk, Gulten Korkmaz, Merve Ecem Erdogan Yon et al.
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Case in brief
A 47-year-old woman with acute myeloid leukemia developed late acute gastrointestinal graft-versus-host disease after allogeneic hematopoietic stem cell transplantation and received methylprednisolone at 1 mg/kg/day. Her fibrinogen fell from 3.44 g/l to 0.35 g/l within 19 days. Clinical, laboratory, and imaging findings did not support disseminated intravascular coagulation or hepatic dysfunction, and she had no major bleeding. After corticosteroids were stopped, fibrinogen recovered rapidly, reaching 1.55 g/l at day 38 postcessation.
What made this case unusual
Profound fibrinogen depletion occurred during corticosteroid treatment without evidence of disseminated intravascular coagulation or hepatic synthetic dysfunction, yet no major bleeding occurred.
Diagnostic / clinical pearl
In a patient receiving systemic corticosteroids for graft-versus-host disease, marked hypofibrinogenemia warrants assessment for other causes and consideration of a steroid association when those causes are unsupported.
Why it matters
The case underscores the potential value of monitoring fibrinogen during high-dose corticosteroid treatment after transplantation.