Fibrinolytic Pathway Disorders

Disorders of fibrinolysis result in bleeding of varying severity with no pathognomonic features distinguishing one disorder from the other. Additionally, these hyperfibrinolytic states are rare and challenging to diagnose due to lack of standardized, reproducible assays which are not widely available. A hematologist should have a high index of suspicion for fibrinolytic disorders if there is delayed bleeding after surgery or trauma and/or heavy menstrual bleeding wherein tier-one evaluation for common bleeding disorders has not yielded conclusive results. Global assays may prove useful in these rare scenarios. Treatment relies on the use of antifibrinolytic therapy and as needed fresh frozen plasma for severe bleeding presentations.