Coagulation works as intended when a person has healthy levels of various clotting factors, which are naturally occurring proteins found in blood —including fibrinogen, also known as factor I.
When the body can’t produce enough functioning fibrinogen or loses fibrinogen during bleeding, a person has a fibrinogen deficiency. Some people are born with a very rare condition called congenital fibrinogen deficiency, while others experience a dangerous drop in fibrinogen due to medical conditions or emergencies, which is known as acquired fibrinogen deficiency.
In fact, this acquired form is not uncommon, occurring in 30-50% of cases involving cardiac surgery, trauma, postpartum hemorrhage (PPH) and liver transplant surgery. This happens because of blood loss, diluted clotting factors from transfusions or serious conditions like disseminated intravascular coagulation (DIC), which make it harder for the body to stop bleeding. Acquired fibrinogen deficiency can result in serious outcomes, including excessive bleeding, increased need for transfusions, prolonged ICU stays and increased morbidity and mortality.
Managing fibrinogen deficiency is key to treating heavy bleeding during surgery or trauma. While current therapies are effective, they come with limitations: delays due to matching donor and recipient ABO blood types for compatibility, frozen storage and thawing, variability in fibrinogen content that affects dosing precision, and waste from short shelf-life once thawed.
Fibrinogen concentrate is an option that may reduce transfusions and improve outcomes. This approach aligns with the systematic, evidence-based strategy known as patient blood management (PBM), which focuses on preserving a patient’s own blood, minimizing unnecessary transfusions and improving outcomes. Though not yet widely used in the United States, the World Health Organization calls for urgent implementation of PBM to improve blood health and reduce risks associated with iron deficiency, anemia, blood loss and clot issues.
Central to PBM is understanding coagulation, the process by which the body stops bleeding and begins to repair itself by forming a clot. You’ve probably heard of dangerous blood clots that can form. But blood also can clot in a healthy, helpful way. And people are also at risk if their bodies can’t complete this coagulation cascade to stop bleeding.
In the complex dance of coagulation, fibrinogen plays a key role by providing scaffolding for the clot to form. You can see fibrinogen at work in a small way when you experience a minor cut and the bleeding stops on its own. Fibrinogen, produced in the liver, is “one of the most abundant plasma proteins playing a key role in hemostasis” and “an important modulator of wound healing and host defense against microbes,” according to a recent medical journal article.
Once a blood clot forms, bleeding stops and healing begins. When the repair is complete, the clot dissolves naturally. This coordinated process, along with the immune system, helps the body control bleeding and repair after injuries.
