What Is Fibrinoid Necrosis?
Fibrinoid necrosis is a form of cellular death that forms a fibrous tissue, often occurring in the blood vessels throughout the body. It happens in the small arteries, arterioles, and glomeruli, carrying blood to all body areas. In fibrinoid necrosis, the inside lining of the blood vessels becomes damaged. When blood vessels become damaged, they can break down, causing lesions in the blood vessels, bleeding, and bruises. Fibrinoid necrosis gets its name because the dead blood vessel cells will form fibrin, a non-globular protein that forms a fibrous material that can stop blood flow through the blood vessels.
What Causes Fibrinoid Necrosis?
Necrosis refers to cell death due to injury, trauma, or lack of blood supply. In fibrinoid necrosis, the immune system is highly active, releasing substances that attach to the inside blood vessels and cause inflammation. This can eventually kill the cells lining the blood vessel.
Any health condition can cause fibrinoid necrosis. High blood pressure can lead to fibrinoid necrosis. Normal blood pressure is 120/80 mmHg. Malignant hypertension is when blood pressure is 180/120 mmHg. This can cause fibrinoid necrosis in the blood vessels of the brain, heart, kidneys, and other organs.
Other conditions that can cause fibrinoid necrosis are:
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Preeclampsia is a pregnancy complication that causes high blood pressure.
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Autoimmune diseases like rheumatoid arthritis, systemic lupus erythematosus (SLE) or lupus, and rheumatic fever.
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Subacute bacterial endocarditis infection of the heart.
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Vasculitis (inflammation of the blood vessels that causes changes in the blood vessel walls.), such as polyarteritis nodosa, Buerger's disease, and IgA vasculitis.
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Rejection of an organ transplant. If a body rejects a newly donated organ, an infection may result. This infection can damage the blood vessels near the transplant site, leading to fibrinoid necrosis.
What Are the Symptoms of Fibrinoid Necrosis?
Because fibrinoid necrosis involves the destruction of the cells' blood vessels, bleeding may occur. Therefore, most symptoms linked to fibrinoid necrosis involve bleeding, including:
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Bleeding gums.
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Nosebleeding (epistaxis).
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Blood in the urine (hematuria).
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Blood in the stool (rectal bleeding).
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Muscle bruises.
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Hemorrhage of the spleen.
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Traumatic and surgical bleeding.
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Menorrhagia and postpartum hemorrhage.
What Are the Potential Complications of Fibrinoid Necrosis?
Complications often have to do with the condition or disease causing it. For instance, in malignant hypertension, fibrinoid necrosis in the kidneys can lead to kidney failure. In systemic lupus erythematosus (SLE), fibrinoid necrosis can lead to skin lesions and heart issues associated with this disease.
How Is Fibrinoid Necrosis Diagnosed?
A healthcare provider conducts a biopsy to collect a tissue sample to study it under a microscope. Biopsy procedures typically depend on the location:
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Internal biopsies involve taking a tissue sample from inside the body. Healthcare providers use a needle or an endoscope (a long, thin, flexible tube with a camera and tiny instruments at the end).
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Skin biopsies involve shaving off a skin's thin layer or using a punch tool or incision to collect a deeper sample.
Fibrinoid necrosis can be identified only in histologic preparations and has no characteristic macroscopic features. In fibrinoid necrosis, tissues often appear eosinophilic (pink with H&E stains) and lose their structural details (becoming amorphous). "fibrinoid necrosis" defines this appearance because it resembles deposits of the blood clotting protein, fibrin.
The importance of fluorescence microscopic investigations with fluorochromes, using Novelli's method, and with certain other procedures are emphasized. Reference has been made to differences in the chemical composition of the fibrinoid substance and its relations to other related substances (keratin, amyloid, and fibrin). A detailed analysis would show that these deposits contain other plasma proteins as well; however, fibrin overshadows other proteins in histologic slides and gives the name to this lesion.
How Is Fibrinoid Necrosis Treated?
There's no standard treatment for bleeding. It depends on the type of bleeding and where it is in the body. Healthcare providers can also treat the conditions that cause fibrinoid necrosis. Medications can reduce blood pressure, suppress the immune system, and restrict further damage to the blood vessels. Healthcare providers can also treat the conditions that cause fibrinoid necrosis.
How to Prevent Fibrinoid Necrosis?
Prevention aims to reduce the risk of developing the underlying conditions that cause it. Check in regularly with a healthcare provider. This is the most effective way to detect and address any health problems that may lead to more serious issues. Follow the healthcare provider's instructions if someone knows they have fibrinoid necrosis.
What Is the Outlook for People With Fibrinoid Necrosis?
The outlook depends on how severe the underlying condition is. Some diseases that cause fibrinoid necrosis can affect a person's quality of life and lead to early death. People who do not receive prompt treatment for malignant hypertension have a life expectancy of only two years. In addition, follow-up care with a healthcare provider is essential. By following the provider's treatment plan, it is possible to manage the condition and prevent further damage.
Conclusion
Fibrinoid necrosis refers to the death of cells in small blood vessels that can lead to bleeding and internal damage throughout the body. Many conditions can cause fibrinoid necrosis, including autoimmune diseases (e.g., systemic lupus erythematosus) and malignant hypertension. There is no standard treatment, but the conditions that cause it are treatable and preventable. The conditions that cause fibrinoid necrosis are serious and require close monitoring by a healthcare provider. Seeing a healthcare provider regularly can help one effectively manage health and prevent potential complications from underlying conditions.
