Cryofibrinogenemia, Multiple Dysproteinemias, and Hypervolemia in a Patient with a Primary Hepatoma

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Abstract
A patient is reported with malignant hepatoma, hyperfibrinogenemia and cryofibrinogenemia. The cryofibrinogen was isolated and determined to be functionally and immunologically identical to fibrinogen. The increased concentration of fibrinogen was not associated with any discernible clinical signs or symptoms. Routine laboratory studies, including liver function studies were normal. A striking feature was a markedly elevated plasma volume of 92 cc/kg determined by 3 different methods. Thus the circulating mass of fibrinogen was 14 times normal. In addition to the increased level of fibrinogen, ceruloplasmin and haptoglobin were also markedly increased. These proteins, being mainly intravascular and increasing the intravascular oncotic pressure, may have caused the extremely large plasma volume. An attempt to demonstrate the hepatoma as the production site for the fibrinogen yielded negative results.