The conversion of fibrinogen to fibrin: A brief history of some key events.

The conversion of fibrinogen to fibrin is a process that has long fascinated an army of researchers. In this brief review some early break-through observations are noted and a few later unexpected results described.

Over 50 Years of Fibrinogen Concentrate.

March 2013 represented the 50th anniversary of the first license granted for a fibrinogen concentrate. In this review, we look at the history of bleeding management that led to the development of fibrinogen concentrate, discuss its current use, and consider future developments for this product.

Treatment of haemophilia patients in East Germany prior to and after reunification in 1990.

The reunification of Germany in 1990 brought with it major challenges in terms of unifying the care offered to haemophilia patients. At that time, most of the treatment centres belonged to the largest regional hospitals. The centre for paediatric haemophilia patients in Leipzig was at the University Hospital. In this centre, early prophylaxis was offered to all patients with severe haemophilia A or B. For over 20 years, the treatments of choice in the German Democratic Republic were cryoprecipitate for haemophilia A and prothrombin complex concentrate for haemophilia B. Cryoprecipitate was relatively effective during minor surgery, in cases of mild to moderate bleeding, and for prophylaxis; however, unpleasant, relevant side-effects and hepatitis virus transmission were frequently encountered in clinical practice. Reunification coincided with the availability of virus-safe, high-purity plasma-derived factor VIII concentrates (e.g. Beriate(®) P), which changed the outlook for patients in terms of convenience, tolerability, and virus safety; and these new products quickly became the treatments of choice for haemophilia A patients at the Leipzig Children's Hospital. Today, 20 years later, nearly all of the patients initiated on Beriate(®) P at the time of reunification continue with that treatment, and are still benefitting from its excellent efficacy, tolerability, and virus-safety profile.

Cryoprecipitate: an outmoded treatment?

Cryoprecipitate is an allogeneic blood product prepared from human plasma. It contains factors VIII, von Willebrand factor (vWF), fibrinogen, fibronectin and factor XIII. Its use was first described in the 1960s for treatment of patients with factor VIII deficiency. It has also been used to treat patients with congenital hypofibrinogenaemia. Now, the most common use of cryoprecipitate is fibrinogen replacement in patients with acquired hypofibrinogenaemia and bleeding. Despite almost 50 years of use, evidence of efficacy is limited. This review provides an overview of the history of cryoprecipitate use, the current debates on the use of this product and future developments.

Deciphering the physiological pathway of clotting of fibrinogen in blood plasma.

I have been fortunate to have benefited over the years from the friendship and advice of John Ferry in our research to decipher the physiological reactions and regulatory events involved in the clotting of fibrinogen in blood. The article is a tribute to the memory of this creative scientist and remarkable individual.

Some comments on John Ferry's most enduring paper.

In this brief memoir, I reflect on the great insight John Ferry exhibited in his extremely influential 1952 paper on the mechanism of fibrinogen being changed into fibrin.

Determining the crystal structure of fibrinogen.

Summary. I have enjoyed reading previous historical sketches that have appeared in Journal of Thrombosis and Haemostasis, and especially those by Ted Tuddenham on factor VIII and Bjorn Dahlback on activated protein C resistance. Like those authors, I have tried to capture some of the excitement-as well as the disappointments-that occurred along the way to a long-term goal.