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Modified approach to fibrinogen replacement in the setting of dysfibrinogenaemia
  1. Jocelyn B Chandler1,2,
  2. Alexa J Siddon1,3,
  3. Parveen Bahel1,
  4. Richard Torres1,
  5. Henry M Rinder1,
  6. Christopher A Tormey1,3
  1. 1 Department of Laboratory Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
  2. 2 Department of Pathology, Yale University School of Medicine, New Haven, Connecticut, USA
  3. 3 Pathology & Laboratory Medicine Service, VA Connecticut Healthcare System, West Haven, Connecticut, USA
  1. Correspondence to Dr Jocelyn B Chandler, Department of Laboratory Medicine, Yale University School of Medicine, New Haven, CT 06511, USA; jlb238{at}gmail.com

Abstract

Most fibrinogen replacement strategies focus on quantitative deficiencies. A thrombin time (TT) mixing study helped to assess qualitative defects caused by dysfibrinogens. Plasma samples were collected from non-anticoagulated subjects (n=6) meeting laboratory criteria for suspected dysfibrinogenaemia (TT > 22 s; fibrinogen activity <180) and from a control group. TT mixing studies were performed on subject plasma with increasing volumes of pooled normal plasma at 1:2, 1:4 and 1:5 dilutions. No subjects with dysfibrinogenaemia demonstrated a complete TT correction at 1:2, but 50% corrected at 1:4 and 100% at 1:5 dilution. Based on these data, a correction factor (CF), defined as the reciprocal dilution yielding complete correction, was incorporated into our clinical practice formula for fibrinogen dosing in patients with dysfibrinogenaemias. Our study incorporates TT mixing studies for assessment of dysfibrinogens. The addition of a mix-derived CF to classical formulae may better approximate dosing in patients with dysfibrinogenaemia.

  • dysfibrinogenemia
  • fibrinogen
  • cryoprecipitate
  • thrombin time

https://doi.org/10.1136/jclinpath-2018-205438

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    Footnotes

    • Handling editor Mary Frances McMullin.

    • Contributors JBC and PB performed the studies. JBC, PB, AJS, RT and CAT analysed the data. JBC, PB, AJS, RT, HMR and CAT wrote the manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent Not required.

    • Ethics approval Yale IRES IRB.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement No additional unpublished data from the study are available.