Fibrinogen Activity

This test is used for diagnosis of homozygous and heterozygous fibrinogen deficiency as well as dysfibrinogenemia, and diagnosis of disseminated intravascular coagulation.^6-8 Fibrinogen levels can be used to assess the effectiveness of thrombolytic therapy.⁹

If the patient's hematocrit exceeds 55%, the volume of citrate in the collection tube must be adjusted. Refer to Coagulation Collection Procedures for directions.

Fibrinogen is an acute-phase reactant and can often become significantly increased in conditions involving tissue damage, infection, or inflammation.⁶ Increased levels may be seen in smokers, during pregnancy, and in women taking oral contraceptives.⁶ Fibrinogen levels can be diminished in advanced liver disease.⁹ Very high levels of heparin, presence of direct thrombin inhibitors, or fibrin breakdown products may falsely reduce fibrinogen levels because they interfere with the rate of clot formation.⁶ Lipemia or hemolysis may interfere with this assay.

The measurement of fibrinogen activity is based on determination of fibrin polymerization function by the Clauss method.¹⁰ This method measures the rate of clot formation after adding a high concentration of thrombin to citrated plasma. The fibrinogen activity is then derived from a standard curve relating the clotting time to plasma standards of known fibrinogen activity.

Besser MW, MacDonald SG. Acquired hypofibrinogenemia: current perspectives. J Blood Med. 2016 Sep 26;7:217-225. PubMed 27713652                 

Casini A, Undas A, Palla R, Thachil J, de Moerloose P; Subcommittee on Factor XIII and Fibrinogen. Diagnosis and classification of congenital fibrinogen disorders: communication from the SSC of the ISTH. J Thromb Haemost. 2018 Sep;16(9):1887-1890. PubMed 30076675

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Hugon-Rodin J, Carrière C, Claeyssens S et al. Obstetrical complications in hereditary fibrinogen disorders: the Fibrinogest study. J Thromb Haemost. 2023 Aug;21(8):2126-2136. PubMed 37172732

Mackie IJ, Kitchen S, Machin SJ, Lowe GD; Haemostasis and Thrombosis Task Force of the British Committee for Standards in Haematology. Guidelines on fibrinogen assays. Br J Haematol. 2003 May;121(3):396-404. 12716361

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STA® - Fibrinogen® 5 Instructions for Use (IFU) [package insert]. June 2018.

Fibrinogen, also referred to as factor I, is a 340-kilodalton glycoprotein that is produced by the liver.⁶ Fibrinogen has a plasma half-life of about four days. Proteolytic conversion of fibrinogen to fibrin occurs through both the extrinsic and intrinsic pathways.⁶ Severe fibrinogen deficiency should be considered when a patient with bleeding history has both extended protime (PT) and activated partial thromboplastin time (aPTT).^7,8 Mild deficiency may not produce prolongation of either the aPTT or PT and, therefore, fibrinogen activity should be measured in individuals with a bleeding tendency even when the aPTT and PT are in the normal reference interval.

Congenital afibrinogenemia, a condition associated with the complete absence of fibrinogen, is rare with only about 150 cases reported in the literature.^6,7 Fibrinogen deficiency is inherited as an autosomal recessive trait.^7,8 Afibrinogenemia occurs in individuals who are homozygous or doubly heterozygous for mutations. These individuals have infinite protime and aPTT results due to the inability to produce fibrin. Approximately 25% of patients with afibrinogenemia have mild thrombocytopenia.⁷

Individuals who are heterozygous for congenital fibrinogen deficiency are usually asymptomatic unless their fibrinogen levels fall to <50 mg/dL.⁷ Both functional (activity) and antigenic levels are diminished in these individuals.⁷ Fibrinogen deficiency affects both males and females with a prevalence that is equal in all ethnic groups.⁷ Acquired deficiencies occur in individuals with significant hepatic dysfunction, renal disease, and after L-asparaginase therapy.⁶ Diminished levels can also be seen in patients with disseminated intravascular coagulation (DIC) or who are undergoing thrombolytic therapy.⁶ Fibrinogen is one of the major determinants of the erythrocyte sedimentation rate and individuals with afibrinogenemia typically have greatly extended sedimentation rates.⁷

Individuals with dysfibrinogenemia have fibrinogen that is qualitatively defective with low functional fibrinogen levels (activity) and normal or decreased antigenic levels.⁶ Congenital dysfibrinogenemia is inherited as an autosomal dominant mutation.⁶ A number of disfibrinogenemic defects have been identified with a variety of manifestations including abnormal fibrin polymerization, impaired fibrinopeptide release, abnormal fibrin stabilization, and abnormal fibrin clot lysis.^6,7 Fibrinogen activity and antigen levels are useful in the diagnosis of dysfibrinogenemia since these individuals often have diminished activity relative to antigen levels.⁸ Typically, dysfibrinogenemia is associated with an elevated thrombin time and greatly elevated reptilase time.

Individuals with afibrinogenemia have a bleeding tendency of varying severity.⁷ Symptoms often start in early infancy with umbilical cord bleeding, intracerebral hemorrhage, or bleeding at circumcision.^6-8 Individuals with afibrinogenemia also suffer from deep muscle and joint bleeding and other mucous membrane bleeding throughout life.⁶ Women with afibrinogenemia typically do not experience menorrhagia.⁸ Patients with heterozygous hypofibrinogenemia usually have a minimal history of bleeding with symptoms only observed after major surgery or trauma.^6,7 Approximately 50% of individuals with dysfibrinogenemia are asymptomatic suffering neither bleeding nor thrombosis.^6,7 These individuals are usually detected when prolonged clotting times are discovered as a result of routine laboratory testing. About one in four will suffer prolonged bleeding after surgery and approximately 20% will have an increased tendency toward thrombosis.⁶

Elevated fibrinogen activity is most consistent with an acute phase response, seen in infection, systemic inflammation, tissue injury, autoimmune disease, or malignancy. Increases may occur during pregnancy or with estrogen exposure. Persistent elevation may be associated with increased cardiovascular risk related to prothrombotic clot architecture. A number of clinical and epidemiological studies have revealed a consistent association between elevated fibrinogen levels and increased risk for atherosclerotic vascular disease;¹¹ however, it remains to be determined whether increased fibrinogen acts as a mediator of arterial thrombosis or simply reflects the inflammation associated with atherosclerosis.¹¹ Marked hyperfibrinogenemia can reduce lupus anticoagulant (LA) assay sensitivity by shortening phospholipid‑dependent clotting times (e.g., aPTT and sometimes dRVVT), partially offsetting inhibitor‑mediated prolongation and yielding false‑negative or borderline results.^15,16