At a Glance
Patient with liver disease or disseminated intravascular coagulation (DIC) on medications such as sodium valproate or L-asparaginase is likely to have fibrinogen deficiency (acquired).
What Tests Should I Request to Confirm My Clinical Dx? In addition, what follow-up tests might be useful?
The following tests are useful to confirm a clinical diagnosis and follow-up initial testing:
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Prolonged thrombin time (TT).
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Prolonged Ppothrombin time (PT).
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Prolonged activated partial thromboplastin time (aPTT).
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Check for heparin, direct thrombin inhibitors (DTI), plasminogen activator, radiocontrast or topical bovine thrombine use.
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Abnormal reptilase time (reptilase, derived from snake venom, cleaves fibrinopeptade A, resulting in the formation of clot; not affected by heparin).
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Correction or noncorrection (in case of inhibitor) of the TT 1:1 mixing study.
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TT 1:1 mix noncorrected; D-dimers increased; DIC likely.
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TT 1:1 mix noncorrected; D-dimers normal; Consider amyloidosis, monoclonal or polyclonal thrombin inhibitor, DTI or heparin; Consider serum immunofixation electrophoresis.
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TT 1:1 mix corrected; fibrinogen activity/antigen ratio decreased; liver function tests increased; acquired dysfibrinogenemia likely.
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TT 1:1 mix corrected; fibrinogen activity/antigen ratio decreased; liver function tests normal; inherited dysfibrinogenemia likely.
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TT 1:1 mix corrected; fibrinogen activity/antigen ratio normal; fabrinogen activity absent; afibrinogenemia likely.
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TT 1:1 mix corrected; fibrinogen activity/antigen ratio normal; fabrinogen activity decreased; consider DIC, hypofibrinogenemia or liver disease.
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Thrombocytopenia, abnormal liver function tests and high fibrin split products/D-dimer (liver disease).
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Thrombocytopenia, high fibrin split products/D-dimer (DIC).
Are There Any Factors That Might Affect the Lab Results? In particular, does your patient take any medications – OTC drugs or Herbals – that might affect the lab results?
Heparin, direct thrombin inhibitor, plasminogen activator, radiocontrast or topical bovine thrombin use may cause prolonged TT.
What Tests Should I Request to Confirm My Clinical Dx? In addition, what follow-up tests might be useful?
Hypofibrinogenemia is defined as a plasma fibrinogen concentration less than 150 mg/dl. Acquired hypofibrinogenemia is common and is seen with severe liver disease, DIC and high volume perioperative fluid replacement.
Are There Any Factors That Might Affect the Lab Results? In particular, does your patient take any medications – OTC drugs or Herbals – that might affect the lab results?
Sodium valproate and L-asparaginase impair hepatic synthesis of fibrinogen.
Antifibrinogen antibodies have been associated with systemic lupus erythematosus, ulcerative colitis, liver cirrhosis, and other disorders.
Fibrinogen degradation products and monoclonal paraproteins may also interfere with normal fibrinogen function.
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