Plasma fibrinogen

Ann Clin Biochem 2004;41:430-440
© 2004 Association for Clinical Biochemistry


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Review Articles

Gordon DO Lowe,
Ann Rumley and
Ian J Mackie

Department of Medicine, University of Glasgow Glasgow, Scotland, UK;
Department of Medicine University of Glasgow Glasgow, Scotland, UK;
Department of Haematology University College London Medical School London

Fibrinogen is the major plasma protein coagulation factor. Lowplasma fibrinogen concentrations are therefore associated withan increased risk of bleeding due to impaired primary and secondaryhaemostasis. Fibrinogen is a classical positive acute-phasereactant protein and is an independent predictor of coronaryheart disease events. This review considers available methodsfor measurement of fibrinogen and makes recommendations as totheir appropriate use.

Total clottable fibrinogen assays are the definitive and referencemethod for plasma fibrinogen measurement. However, they aretime-consuming and are rarely required in clinical practice.Clotting rate assays remain the routine method of choice forinvestigation, monitoring and treatment of bleeding disordersassociated with low plasma fibrinogen concentrations. They areappropriately sited in haematology or haemostasis laboratories,with facilities for further relevant investigations, and expertadvice from consultant haematologists on appropriate management.They have also been used in the majority of studies investigatingincreasing fibrinogen concentrations as a cardiovascular riskfactor. Prothrombin-time derived assays are widely used, becausethey are less expensive and come at no extra cost with prothrombintime assays. However, their results vary widely with analysersand reagents, show discrepancies with clotting rate assays forboth low and normal plasma fibrinogen samples, and at presentthey are not recommended by routine clinical use. Immunoassays(radial immunodiffusion, enzyme-linked immunosorbent assay ornephelometric) are useful in (a) differentiating hypofibrinogenaemiafrom dysfibrinogenaemia, and (b) assessing cardiovascular riskand acute-phase reactions. Unlike clottable fibrinogen assays,immunoassays can be performed in dipotassium edetate anticoagulatedsamples.

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