Blunt Trauma without Elevated Fibrin Degradation Product
Year: 2024
Type: article
Abstract: Dear Editor, Fibrin degradation product (FDP) is a useful biomarker in trauma care.[1-3] In this report, we describe a case of blunt trauma that showed marked anemia progression despite relatively mild trauma and normal FDP. A 90-year-old woman with a history of hypertension, reflux esophagitis, cataracts, and a left knee ganglion, who was independent in daily living, accidentally fell down the stairs. She was monitored for a while but showed no improvement, so she requested an ambulance and was transported to our hospital approximately 6 h after the injury. On arrival, her vital signs were stable. On physical examination, swelling and tenderness were observed in the head and left buttocks. Traumatic pan scan revealed transverse process fractures of lumbar vertebrae 1–4 and a massive hematoma of the left buttock [Figure 1]. The results of blood count and biochemical analysis showed that the white blood cell count, 11,200/µL; hemoglobin (Hb), 11.3 g/dL; platelet, 32.0 × 104/µL; prothrombin time-international normalized ratio, 0.84; activated partial thromboplastin time, 24.4 s; fibrinogen, 238 mg/L; and FDP 3.2 (normal value, <5.0) µg/mL. She was admitted to the hospital for observation, and her vital signs remained stable, but her Hb level decreased to 7.9 g/dL on the 3rd day. Her anemia improved with a minimum value of 7.9 g/dL, and she was discharged without a blood transfusion.Figure 1: Computed tomography (CT) on arrival. The CT showed a massive hematoma (arrow) of the left buttockThis patient had mild trauma and a normal FDP level on arrival but experienced a 3.4 g/dL drop in Hb and progression of anemia that would have warranted a blood transfusion. Normally, a patient with blunt trauma would require a blood transfusion if the FDP is over 100 µg/mL at presentation.[4] However, to our best knowledge, there has been no case of blunt trauma where the patient had a normal FDP level at presentation but later experienced a drop significant enough to almost require a blood transfusion. One reason the FDP was normal is thought to be the delay in coming to the hospital, which was 6 h after the accident. It is possible that the FDP, which initially exceeded the normal value, decreased over time and fell to the normal value when the patient came to our hospital.[5] A second reason for the normal FDP value may be the lack of elevation due to the nature of the massive hematoma formed by the trauma. Since the hematoma was a blood clot separated from the surrounding tissue, it was difficult for it to come into contact with fibrinolytic substances such as plasmin, which are necessary for conversion to FDP. It is possible that there was an inborn error in the fibrinolytic process that affects the conversion of fibrin to FDP, but this has not been investigated. It is important to note that while FDP values are useful in diagnosing blunt trauma, they may not be elevated in cases of delayed presentation or massive hematoma formation. Research quality and ethics statement This study was approved by the Institutional Review Board (Juntendo Shizuoka Hospital Ethics Committee IRB # 298). All authors followed applicable EQUATOR Network (http://www.equator-network.org/) guidelines during the conduct of this research project. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understands that her name and initials will not be published and due efforts will be made to conceal her identity. But anonymity cannot be guaranteed. Financial support and sponsorship This work was supported in part by a grant-in-aid for special research in subsidies for ordinary expenses of private schools from the promotion and mutual aid corporation for private schools of Japan. Conflicts of interest There are no conflicts of interest.
Institutions: Juntendo University, Juntendo University Shizuoka Hospital
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $600
OpenAlex ID: W4405737985