What is the role of soluble fibrinogen measurement in the workup of disseminated intravascular coagulation (DIC)?

Updated: Dec 06, 2020
  • Author: Marcel M Levi, MD; Chief Editor: Srikanth Nagalla, MBBS, MS, FACP  more...
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Answer

Because fibrin activation is a central component of DIC, it would seem logical to assume that if soluble fibrin is elevated, the diagnosis of DIC can be made with confidence. [61] However, soluble fibrin levels are not available to most clinicians within a relevant time frame. Likewise, laboratory assays aimed at differentiating between cross-linked fibrin, fibrinogen, and soluble fibrin have been developed but are not routinely available to the clinician.

The massive fibrin deposition in DIC suggests that fibrinogen levels would be decreased. Accordingly, measurement of fibrinogen has been widely advocated as a useful tool for the diagnosis of DIC; however, it is in fact not very helpful. Fibrinogen, as a positive acute-phase reactant, is increased in inflammation, and whereas values may decrease as the illness progresses, they are rarely low. [16, 62] One study demonstrated that in up to 57% of DIC patients, the levels of fibrinogen may in fact remain within normal limits. [56]

In a consecutive series of patients, the sensitivity of a low fibrinogen level for the diagnosis of DIC was only 28%, and hypofibrinogenemia was detected in a very small number of severe cases of DIC only. Sequential measurements of fibrinogen might be more useful and might be more likely to provide diagnostic clues.


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