Fibrinogen is one of the first coagulants to drastically fall as a result of consumption, dilution or loss during major trauma, surgery and postpartum haemorrhage. The outcome is a reduced ability to form blood clots which can lead to excessive bleeding if left untreated. Indeed, low fibrinogen levels have been correlated to excessive blood loss during trauma, surgery and to the severity of postpartum haemorrhage, both of which present an increased risk of mortality (Frith et al., 2010; Rainer et al., 2011; Cortet et al., 2012; Gielen et al., 2014; Walden et al., 2014; Liu et al., 2018). Fibrinogen replenishment has been shown to improve outcome and therefore early assessment of fibrinogen levels and activity should be a key consideration for perioperative management (Mallaiah et al., 2015; Matsunaga et al., 2017; Li et al., 2018).

Fibrinogen replenishment may prevent excessive bleeding and save lives. Early assessment of fibrinogen deficiency using reliable and rapid diagnostic tests should therefore be at the forefront of perioperative management. 

Quantitative and functional assays for measuring fibrinogen levels and activity

Figure 10. Quantitative and functional assays for measuring fibrinogen levels and activity.
ELISA, enzyme-linked immunosorbent assay; FF, functional fibrinogen; FIBTEM, fibrin-based extrinsically activated test; PT, prothrombin time; ROTEM, rotational thromboelastometry; TEG, thromboelastography.

In this section, we discuss and compare the available diagnostic tools for measuring fibrinogen levels (quantitative assays) and quality (functional assays) (Figure 1). We also highlight recent data on the increasing use and reliability of point-of-care viscoelastic functional assays such as rotational thromboelastometry (ROTEM) and thromboelastography (TEG).

Traditional functional assays

Traditional functional assays<br></br>

Here we look at the Clauss assay and prothrombin time (PT)-derived fibrinogen assay.

Point-of-care functional assays

Point-of-care functional assays

Gain insight into the increasing use of ROTEM (FIBTEM and EXTEM) and TEG.

Quantitative fibrinogen assays

Quantitative fibrinogen assays <br></br>

Learn about immunological techniques such as ELISA and clottable protein assay.

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