Perioperative blood management in patients with lung cancer complicated with dysfibrinogenemia

To analyze perioperative blood management strategies in patients with lung cancer and concomitant dysfibrinogenemia. A case of lung cancer complicated by dysfibrinogenemia was identified at Shandong Provincial Cancer Hospital. Genetic sequencing revealed a pathogenic variant associated with dysfibrinogenemia. During the perioperative period, we systematically monitored the patient’s coagulation parameters, hematological indices, and biochemical markers. We also comprehensively analyzed and summarized the dynamic changes in these parameters and their implications for coagulation risk. The patient showed mild prolongation of prothrombin time and thrombin time, significant decrease in Clauss fibrinogen, whereas activated partial thromboplastin time, fibrin degradation products, and D-dimer levels were all within normal limits. The K-value was slightly increased and the angle decreased, suggesting impaired clot formation, whereas all other hemostatic and thrombotic parameters remained unremarkable. Genetic testing revealed a pathogenic FGG variant in this patient (NM_021870.3, exon 8, c.901 C > T, p.R301C). After the infusion of cryoprecipitate, the plasma fibrinogen concentration rose to 0.74 g/L. Surgery was performed with safe hemostasis ensured. Postoperatively, fondaparinux sodium was injected to prevent thrombosis. Throughout the perioperative period, the patient’s condition was remainned stable, and no complications were observed. Patients with dysfibrinogenemia present a spectrum of clinical manifestations and have higher risks of bleeding and thrombosis than unaffected individuals. Patients with lung cancer complicated by dysfibrinogenemia face greater challenges during surgical treatment. Therefore, treatment strategies should be formulated according to the patients’ bleeding history and coagulation and hemostatic parameters to maintain a balance between bleeding and thrombosis risks. Fibrinogen replacement therapy may be considered for patients with bleeding tendencies, among whom human fibrinogen concentrate is the preferred option. The timing and choice of perioperative thromboprophylaxis should be individualized based on the dynamic balance between thrombotic and bleeding risks.