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BACKGROUND: Pediatric patients are at high risk of massive bleeding after cardiac surgery under cardiopulmonary bypass (CPB). Fibrinogen is essential for coagulation; however, pediatric patients with congenital heart disease (CHD) present abnormal fibrinogen function. The pre- and post-operative fibrinogen level may affect the bleeding and transfusion amount in patients undergoing cardiac surgery. However, the relationship between plasma fibrinogen levels and the bleeding and transfusion amount in pediatric cardiac surgery remains unclear. This study aimed to assess the association of pre-CPB fibrinogen levels (PreFib) and post-CPB fibrinogen levels (PostFib) with postoperative bleeding and transfusion volume in pediatric cardiac surgery. METHODS: We reviewed the medical records of 375 newborns and infants who underwent cardiac surgery under CPB for CHD. The primary endpoint was the correlation of the PreFib and PostFib values, as well as their difference (FibGap), with the bleeding and transfusion amount within 24 postoperative hours. RESULTS: There was no correlation of the PreFib, PostFib, and FibGap values with the bleeding and transfusion amounts at postoperative 24 hours. However, patients with PreFib and PostFib values of

Background COVID-19 infection is associated with a hypercoagulable state. Severe COVID-19 patients present with high plasma fibrinogen levels, continuous deposition of fibrin and the presence of microthrombi in their lungs, accompanied by significant fibrinolysis, resulting in high D-dimer levels. Due to the role of FXIII in fibrin crosslinking and clot stabilization, we analyzed its activity levels and dynamics in COVID-19 patients hospitalized in the intensive care unit (ICU). Methods FXIII levels were measured in thirty four COVID-19 patients hospitalized in the ICU and in fourteen non-severe COVID-19 patients. FVIII levels were measured for comparison. Laboratory data and clinical variables were recorded. Results The average FXIII activity level in 34 ICU hospitalized COVID-19 patients was 69.9±33 %, significantly lower compared to an average of 120±20.9 % FXIII activity in 14 non-severe COVID-19 patients. FXIII activity levels were below the low normal value (< 79 % FXIII activity) in 74 % of the ICU hospitalized COVID-19 patients. In contrast, high FVIII activity was measured among all severe COVID-19 patients. Consecutive measurements, performed in fourteen ICU hospitalized COVID-19 patients, pointed to a significant decrease in FXIII activity from the average of 85.7±28.2 %, (which is in the normal range), to an average of 68.0±20.4 %, below the low normal range, within 6.4±3.4 days of ICU hospitalization. Liver functions did not differentiate between patients with low and normal FXIII activity. No inhibitor to FXIII activity was found in the plasma of severe COVID-19 patients. Levels of FXIII-A antigen correlated with FXIII activity, and were low in severe COVID-19 patients. Conclusions Low FXIII activity levels were found in COVID-19 patients hospitalized in the ICU, with gradual decline during their hospitalization. A mechanism of consumption may account for the low FXIII activity in these patients.

BACKGROUND Fresh frozen plasma (FFP) is used to treat coagulation disorders. Even though the activity of labile coagulation factors gradually decreases once thawed, it can be used up to 24 h after thawing, if stored properly. In this study, the level of coagulation factor activity was evaluated in thawed plasma during a 5 day storage period. MATERIALS AND METHODS This cross-sectional study was performed on 40 FFP units prepared in Yazd Blood Center. Samples were thawed in a waterbath for 20-30 min at 30-37°C and then stored in the hospital blood bank refrigerator. The level of fibrinogen concentration, as a stable factor and, coagulation factors V and VIII, as labile factors, were measured in the plasma immediately following the thawing process as well as 24 and 120 h after the process. Data analysis was performed using SPSS software 20. RESULTS The fibrinogen level remained stable for up to 24 h after thawing; after 120 h there was a 1.66% decrease with the mean level of 334.0 ± 53.3 mg/dl. The mean activity of factors V and VIII levels decreased by 12.3%, and 26% respectively over 120 h after thawing when compared to that after 24 h. A 120 h after thawing Factor V activity was above 70% in 87.5% of thawed plasmas and its mean activity was 81.6 ± 11.8. Factor VIII activity was above 70% in only 35% of thawed plasmas with the mean activity of 64.4 ± 17.2. CONCLUSION Thawed plasma can be used for up to 5 days in all therapeutic applications of FFP since it still has the essential hemostatic effects. However, in situations where higher levels of FVIII are needed, Thawed Plasma is not a suitable alternative. In such cases FFP, FVIII concentrate or cryoprecipitated antihemophilic factor should be used.

Fibrinogen is a key coagulation protein that is necessary for the formation of stable clots. Fibrinogen levels have been reported to be one of the first to fall during major haemorrhage reflecting consumption, dilution and fibrinogenolysis. Its role in acquired major haemorrhage, both in relation to the contribution it plays to the coagulopathy of major bleeding that can exacerbate bleeding and how effective fibrinogen supplementation can be at improving clinical outcomes, has received a great deal of attention over the last 10 - 15 years. This commentary focuses on just three of the more recent publications from the last 5 years that provide some of the evidence behind how we can think about fibrinogen as a haemostatic treatment for acquired major haemorrhage and how we can use the laboratory thresholds to guide therapy.

Fibrinogen increases in the acute inflammatory response since it is an acute-phase reactant. Fibrinogen was defined as an independent risk factor for cardiovascular diseases. We aimed to assess the alterations in plasma fibrinogen levels in patients with obstructive sleep apnea syndrome (OSAS) by comparing them with the control cases and determine their relationship with polysomnography (PSG) parameters. The study included 125 newly diagnosed patients with moderate to severe OSAS (defined as apnea-hypopnea index [AHI] ≥ 15) and 82 non-apneic control subjects (AHI [Med-Science 2021; 10(3.000): 770-4]

Angiosarcoma of the head and neck (ASHN) is one of the most aggressive malignancies of the skin, but the prognostic factors are not well known because of its rarity. Recently, high plasma fibrinogen levels were reported to predict poor prognosis in several malignancies. In the present retrospective study, we suggest that low plasma fibrinogen levels predict poor prognosis for ASHN.

The use of powdered hemostatic products and propolis-based preparations has become increasingly common to control bleeding and aid healing. This study evaluated two hemostatic dressings, one based on propolis (Alveolex®) and the other on ferric subsulfate powder (Quick Blood Stopper®), on experimental wound in quails. The experiment was conducted with 36 quails assigned to three groups: control, propolis-based hemostatic dressing and ferric subsulfate-based hemostatic dressing, on two types of wounds, superficial (skin and subcutaneous) and deep (skin, subcutaneous and muscle). Pre- (day-7) and post-procedure (days 2 and 10) examinations showed a tendency to reduce hematocrit values on day 2 and a tendency to increase fibrinogen levels and total leukocyte count on the same day. Visual assessment of wound healing indicated that birds using Quick Blood Stopper® showed signs of poor healing, while the group treated with Alveolex® had uncomplicated healing within the expected time. The groups treated with hemostatic based on ferric subsulfate showed a tendency to increase the values of fecal corticosterone metabolites on day 10, suggesting an increased level of stress in these animals. During the surgical procedure, both hemostatic products controlled bleeding, but Alveolex®was more efficient and easy to handle.

Coronary artery disease (CAD) is the leading cause of mortality and morbidity both in developed and developing countries. Percutaneous recanalization of occluded coronary artery is one of the treatment options and reinfarction and restenosis negatively affect the outcome following procedure. Although various factors including fibrinogen are suspected as risk factors for this but its role in adverse outcome after stent implantation is controversial. The aim of this study was to determine the impact & relation of periprocedural fibrinogen level on outcome after coronary stent implantation. This prospective study was conducted in the Department of Cardiology, University Cardiac Centre, Bangabandhu Sheikh Mujib Medical University (BSMMU), Hospital, Dhaka over a period of one year between July 2016 to June 2017. Total 53 patients of chronic stable angina (CSA) undergoing elective PTCA followed by stenting were included in this study as per inclusion and exclusion criteria. Plasma fibrinogen level was measured by collecting venous blood samples at three timed points in relation to stenting – 24 h before, 24 h after and 72 h after stenting. Recurrence of angina, myocardial infarction, repeat revascularization (either PCI or Cardiac surgery), and death were considered as adverse outcome during follow up at 1, 3 and 6 months after intervention. During the 6 months follow up period 1 (one) patient developed UA (at 1 month), 2 developed MI (1 at 3 month and 1 at 6 month) and 2 died (1 at 3 month and 1 at 6 month). Patients were grouped on the basis of four outcomes: favorable outcome (those who did not develop any of the four outcomes) and unfavorable or adverse outcome (those who developed any of the four outcomes). The mean age of study population was 53.92 years and 39 (73.6%) were male. Regarding cardiovascular risk factors, 43.4% patients had diabetes mellitus, 88.6% had dyslipidaemia, 56.6% were non-smokers. Baseline plasma fibrinogen level were significantly higher in patients who developed complications following PCI than those who did not develop the complications (394.4 ± 16.0 Vs 271.5 ± 21.8 mg/dl) & remained high after 24 hours and 72 hours following PCI (p < 0.001). Angiographic profiles of the study population reveals 84.9% LAD, 16.9% RCA & 15% LCX involvement but there was no association of post-PCI adverse outcomes with vessels involved, number of stents deployed and types of stents used (p > 0.05). Study showed that the risk of developing unfavorable outcome following PCI in patients with pre-PCI & post-PCI high serum fibrinogen was estimated to be 5.7 times & 12 times higher than those who have had serum fibrinogen lower than 350 mg/ dl respectively (p = 0.023 & 0.025 respectively). High serum fibrinogen can therefore be used as a marker for predicting adverse outcome following PCI. University Heart Journal Vol. 17, No. 2, Jul 2021; 122-127

Background/aim Familial Mediterranean fever (FMF), the most common autoinflammatory disease in children, is characterized by recurrent febrile episodes. FMF is known to progress with chronic inflammation, particularly during attack periods. This study aimed to investigate the relationship of S100A12, an inflammatory marker, with attacks and inflammatory events in FMF patients. Materials and methods The study included 57 patients diagnosed with FMF, 43 in an attack-free period and 14 in an attack period, and 31 healthy children as the control group. Only white blood cell (WBC) count, C-reactive protein (CRP) level, erythrocyte sedimentation rate (ESR), and S100A12 level were analyzed in the control group. In addition, serum amyloid A (SAA), and fibrinogen levels were measured, and a mutation analysis was performed in the patient group. The results were compared among the attack-free period, acute attack FMF and control groups. Results The mean age of patients and control group was 10 (2.5–18) and 9.5 (2.5–16) years, respectively. The CRP (p = 0.001), S100A12 (p = 0.003) and ESR (p= 0.001) values differed significantly between the FMF and control groups. S100A12 level (p = 0.027), WBC count (p = 0.003), CRP level (p = 0.0001), ESR (p = 0.004), and fibrinogen level (p = 0.001) differed significantly between the acute attack and attack-free period groups. SAA level (p = 0.05), ESR (p = 0.001), fibrinogen level (p = 0.001), WBC count (p = 0.001), and S100A12 level (p = 0.027) were higher in M694V homozygous FMF patients than in other FMF patients. Conclusion Patients with FMF had higher S100A12 levels than the control group, while the mean S100A12 concentration was higher in acute attack period patients than in attack-free period patients. S100A12 level might be an important indicator in the monitoring of chronic inflammation in patients with FMF.

Introduction Chronic obstructive pulmonary disease (COPD) has great implications on global health accounting for significant morbidity and mortality. It is a state of chronic inflammation of airways. The aim of this study was to measure the plasma fibrinogen level in patient with COPD and find the relationship between plasma fibrinogen levels and severity of airflow obstruction. MethodsThis observational study was conducted from September 2017 to October 2018, where 80 eligible patients with the diagnosis of acute exacerbation of COPD (AECOPD) were included in the study and their plasma fibrinogen level was measured at the time of discharge. Clinical information was obtained and pulmonary function test (PFT) was done. ResultA total of 80 patients were enrolled. The mean age of the patient was 67.87±11.60 years. Plasma fibrinogen level was 159±12.72 mg/dl in mild COPD, 273.52±62.34 mg/dl in moderate COPD, 312.30±103.67 mg/dl in severe COPD, and 487±102.76 mg/dl in very severe COPD. The comparison between groups showed significant difference in plasma fibrinogen level (p

Background: Prevalence of coronary artery disease (CAD) among Bangladeshi population is higher in urban than rural population. Among the conventional risk factors diabetes mellitus is a major concern for Bangladeshi population. Fibrinogen (Fg) in plasma is associated with severity of CAD in some populations with acute coronary syndrome. Objective: The aim of the study was to find out the correlation between circulating fibrinogen level and severity of coronary artery disease in patients with type 2 diabetes mellitus with chronic stable angina (CSA). Methods: The study was carried out in the Department of Cardiology, National Institute of Cardiovascular Diseases (NICVD), Dhaka from October 2015 to March 2016.Total 132 patients with chronic stable angina (CSA) and type 2 diabetes mellitus who got admitted for coronary angiogram were included in the study and they were divided into 2 groups according to the on admission level of fibrinogen. Coronary angiogram (CAG) was performed in all patients. The severity of the CAD was assessed by angiographic vessel score and Gensini score. Results: Mean Gensini score was 27.0±22.3 vs 22.2±16.4 and mean vessel score 1.6±0.9 vs 1.2±1.0 in group I and group II respectively (p=0.03 and 0.04, respectively). There was positive correlation between Fg and CAD severity in term of vessel score (r=0.19) and Gensini score (r=0.15). Univariate and multivariate analysis revealed that dyslipidemia, smoking and elevated fibrinogen were the independently significant predictors of severe CAD in type 2 diabetic patients with CSA. Conclusion: Elevated plasma fibrinogen positively correlates with the severity of CAD in patients with diabetes mellitus having chronic stable angina. Bangladesh Heart Journal 2020; 35(2) : 106-113

Patients critically ill with COVID-19 are at risk for thrombotic events despite prophylactic anticoagulation. Impaired fibrinolysis has been proposed as an underlying mechanism. Our objective was to determine if fibrinolysis stimulated by tissue plasminogen activator (tPA) differed between COVID patients and controls. Plasma from 14 COVID patients on prophylactic heparin therapy was obtained and compared with heparinized plasma from 14 different healthy donors to act as controls. Kaolin activated thromboelastography with heparinase was utilized to obtain baseline measurements and then repeated with the addition of 4 nM tPA. Baseline fibrinogen levels were higher in COVID plasma as measured by maximum clot amplitude (43.6 ± 6.9 mm vs. 23.2 ± 5.5 mm, p

Elevated fibrinogen (Fbg) levels contribute to tumor progression and metastasis. However, little is known regarding the association of the clinicopathological characteristics and the prognosis of hilar cholangiocarcinoma (HC) with plasma fibrinogen. Data on the plasma Fbg levels, clinicopathological characteristics, and overall survival were retrospectively collected. Plasma fibrinogen concentrations over 4.0 g/L were classified as hyperfibrinogen, elevated fibrinogen, or abnormal fibrinogen levels. We then analyzed the relationships among plasma fibrinogen level, clinicopathological features, and patient prognosis. A total of 171 HC patients were included. An elevated plasma fibrinogen level was associated with lymph-node metastasis (P

Fibrinogen has been identified as a major independent risk factor for cardiovascular diseases. Myocardial infarction is cardiomyocyte death as result of a prolonged ischemia. The aim of this study was to determine fibrinogen level in Sudanese patients with myocardial infarction. A case control study was conducted in AL-Shaab Hospital and Sudan heart center at Khartoum state, Sudan. A total of 100 study participants were enrolled in the study; 50 were myocardial infarction patients and 50 were apparently healthy individuals as control. The blood Samples were collected in 3.2 % trisodium citrate and Fibrinogen level was measured using ready kits principle. The data were analysed by statistical package of social sciences version 21. The study revealed that fibrinogen level was higher in Myocardial infarction (MI) patients compared with normal individuals. There is a significant strong positive correlation between fibrinogen and Troponin-1 Level at the 0.05 level.

Fibrinogen plays a vital role in normal homeostasis by promoting platelet aggregation, clot formation and fibrinolysis. It is quantified in finished pharmaceutical products using different methods described in pharmacopoeia, but these are inaccurate, difficult to validate and do not allow for identification of aggregates or protein products of the same formulation. The aim of this study was to develop and validate a method for quantification of the content of fibrinogen and other proteins present in pharmaceutical formulations by comparing it with current pharmacopeial methods. Fibrinogen was quantified in two commercial products and compared to a pharmacopeial method using a validated method for size-exclusion high-pressure liquid chromatography (SEC-HPLC). The fibrinogen level was in accordance with both products' specifications. The SEC-HPLC method showed that the percentage of fibrinogen was 94.88 for one product and 50.68 for the other, and detected high molecular weight aggregates in the second product. The SEC-HPLC method that we developed is an improvement to the current pharmacopeial method, because it allows for quantification of fibrinogen and determination of product purity. This is important because greater purity can reduce potential adverse effects of pharmaceutical products in patients.

Defects in both coagulation initiation and fibrinolysis have been identified in Chronic Kidney Disease (CKD) patients and patients on dialysis may have higher rates of Cardiovascular Disease (CVD) events.

CONTEXT: Congenital fibrinogen deficiency is a rare inherited coagulation disorder with an estimated prevalence of 1:1,000,000 which is characterized by bleeding that varies from mild to severe and by an extremely low level or complete absence of plasma and platelet fibrinogen. AIMS: This study aims to assess prevalence, demographic parameters, clinical presentation, and hemostatic values in patients diagnosed with congenital fibrinogen deficiency. SETTINGS AND DESIGN: A retrospective descriptive study of patients diagnosed with congenital fibrinogen deficiency in Hemophilia Center/Medical City/Baghdad over a period of 7 years (from August 2008 to August 2015). SUBJECTS AND METHODS: The study included patients diagnosed with congenital fibrinogen deficiency. The confirmation of diagnosis was done based on a low fibrinogen assay. All the fibrinogen deficient patients were diagnosed on basis of having fibrinogen level (

COVID-associated coagulopathy is currently widely discussed in the medical press. There are no unambiguous ideas about its mechanisms and significance at the present time. One of the manifestations is hyperfibrinogenemia. The study of specific changes in this laboratory indicator is of interest from the point of view of evaluating the prognosis of the course of coronavirus infection and selecting therapy. Objectives. Analysis of plasma fibrinogen dynamics in patients with COVID-19, assessment of clinical and prognostic significance of the indicator. Materials and methods. The retrospective study included 350 patients undergoing inpatient treatment for SARS-CoV-2 infection. At the time of analysis, 49 patients (14 %) died, and the rest were discharged from the hospital. The dynamics of fibrinogen content was evaluated, compared with the outcomes of the disease, clinical complications of a thrombotic or hemorrhagic nature, and other laboratory indicators. Results and conclusion. A characteristic feature of COVID-associated coagulopathy is hyperfibrinogenemia (the maximum value of fibrinogen is 6.2 ± 1.7 g/l) as a manifestation of systemic inflammation with a transition in 14 % of patients to hypofibrinogenemia (the minimum value is 1.57 ± 0.29) due to hepatic dysfunction and consumption coagulopathy. In the context of pharmacological antithrombotic prevention, hyperfibrinogenemia did not show clinical significance as a risk factor for thrombosis, while a decrease in fibrinogen less than 2.0 g/l was associated with a 9-fold increase in the risk of hemorrhagic complications in patients with coronavirus infection (OR 9.913 СI 95 % [1.613–60.931]). A decrease in fibrinogen below normal values and an excess of 9.0 g/l are equally predictors of an adverse outcome in patients with COVID-19. The relative risk of death was 3.263 СI 95 % (1.970–5.407) and 2.574 СI 95 % (1.265–5.237), respectively.

Background/Objectives Early diagnosis of pancreatic ductal adenocarcinoma (PDAC) is important as PDAC can lead to mortality; however, no specific biomarker has been identified for its early diagnosis. We previously identified fibrinogen α chain as a promising biomarker for differentiating between patients with and without PDAC using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry. Here, we aimed to validate the clinical usefulness of serum fibrinogen as a biomarker for PDAC. Methods From 2009 to 2011, blood samples of 67 PDAC patients and 43 healthy adults (controls) were prospectively collected. Serum fibrinogen levels and their clinical significances were evaluated. Results Mean fibrinogen levels were significantly higher in the PDAC group than in the control group (3.08 ± 0.565 vs. 2.54 ± 0.249 log10 ng/mL, P Conclusions Serum fibrinogen levels may be a useful biomarker for diagnosing and predicting PDAC prognosis.

Background: Plasma fibrinogen is an indicator of inflammation and endothelial dysfunction has been described as an independent risk factor for cardiovascular morbidity in type 2 Diabetes mellitus patients. Poor glycemic control has been reported to be associated with hyperfibrinogenemia and its complications. This study was aimed to find a correlation of mean fibrinogen level with glycemic control in complicated and uncomplicated cases of Type 2 Diabetes mellitus. Materials and methods: One hundred eight known cases of Type 2 Diabetes mellitus aged ≥ 30 were included in our study of which 39 cases were uncomplicated and 69 cases were complicated Diabetes mellitus. Hundred of non-diabetic age and sex-matched controls were analyzed. Blood samples were collected in Ethylenediaminetetraacetic acid and citrate bulb for estimation of HbA1c and plasma fibrinogen level respectively. Results: Mean fibrinogen level in complicated Type 2 Diabetes mellitus was high 450.43 ±108.51 mg/dl as compared to uncomplicated cases 372.30±123.78 mg/dl (p=0.0001). Mean HbA1c in total Diabetes mellitus cases was 8.02±1.88 mg/dl with a range of 5.50-14.50 mg/dl. A positive correlation was found between HbA1c and mean fibrinogen level (r=0.782, p= 0.001) in type 2 Diabetes mellitus. Duration of diabetes in years showed a significant correlation with mean fibrinogen levels (r=0.295, p=0.002). Conclusions: Plasma fibrinogen level was significantly associated with glycemic control (HbA1c) and duration of Diabetes mellitus in years. Thus, lowering plasma fibrinogen levels could be an important approach to the prevention of cardiovascular complications in diabetics.

Taking into account the impact of shipment method of biosamples is necessary for obtaining high-quality biological samples in biobanking and laboratory research. The impact of liquid nitrogen, dry ice and cold accumulators on the quality of biological markers was considered, as well as recommendations to reduce the impact of these methods of shipment. The liquid nitrogen provides the best preservation of samples, however, dry ice is used much more often during their transportation. When transporting certain types of cells using dry ice, there is the way to use CryoStor CS1 and Cell Banker 1 cryoprotectors. The dry ice has a significant effect on both the pH of liquid biological samples and the coagulological parameters of plasma samples. The penetration of CO2 into the sample leads to changes in the parameters of PTT and APPT, as well as to decrease the protein C and fibrinogen level under certain conditions. Serum and plasma samples exposed to dry ice for more than 16 hours should be thawed open at room temperature, or instead of it should be kept at -80 °C for 24 hours to avoid changes in coagulation parameters, The use of cold accumulators is unacceptable for long-term shipment of serum and plasma containing unstable biomarkers because of insufficiently low temperature (increase over time to -25 °C and above). Besides, metal pellets can be used as cold storage batteries at low temperatures (up to -80 ° C), but they are not as effective as dry ice, since it is able to hold the required temperature for much longer.

Background Fibrinogen may play an important role in the survival of trauma patients; however, its role in traumatic brain injury (TBI) and its correlation with disease prognosis remain poorly understood. The aims of this study were to determine the incidence of TBI-associated hypofibrinogenemia in patients with TBI and to evaluate the prognostic value of fibrinogen level with respect to mortality and clinical outcomes. Methods A total of 2570 consecutive TBI patients were retrospectively studied. Prognostic evaluations were determined using the Glasgow Outcome Score (GOS) assessment 3 months after injury. The shape of the relationship between fibrinogen level and mortality or outcome was examined using cubic spline functions. Logistic regression analyses were conducted to identify the association between fibrinogen level and 3-month functional outcomes. Results Fibrinogen concentrations P < .001). By contrast, for patients with fibrinogen levels P = .003). Similar results were also seen for patients with fibrinogen levels > 3.0 g/L, with the levels being an independent prognostic factor for favorable outcomes at 3 months (OR, 0.771; 95% CI, 0.607–0.979; P = .033). Conclusions Fibrinogen is an independent prognostic factor for clinical outcomes in TBI patients. Maintaining the level of fibrinogen between 2.5 and 3 g/L may improve clinical outcomes in patients with TBI.

BACKGROUND: Type II diabetes, fibrinogen levels have been demonstrated to predict the progression to overt nephropathy. Hyperfibrinogenemia, an indicator of inflammation, is also associated with the presence of endothelial dysfunction, insulin resistance, hypercoagulability, and increased blood viscosity and is a marker of unstable atherosclerotic lesions. AIM: This study aimed to evaluation of coagulation profile and D-dimer and estimation of Serum Fibrinogen Level in Sudanese Patients with type II Diabetes Mellitus in Khartoum State. METHODS: A questionnaire was designed to collect information about the study group, Blood sample were collected from all participants in Tri sodium citrate containers. Automated coagulometer (COATRON M1) was used to evaluate prothrombine time and activated partial thromboplastine time and measure fibrinogen level. D-dimer levels were evaluated using (ichroma™) Reader fluorescence scanning instrument an integrated Point of Care Test (POCT) system. RESULTS: The study showed that the mean and standard of PT, APTT, INR was (17.9 ± 3.8 sec, 32.6 ± 4.1 sec, 1.1 ± 0.3 respectively), the mean of age among study group was (53 ± 14.2 years), there was significant different when correlate PT and management of disease (p. value 0.01) . the present study show insignificant correlation between PT and treatment, complication and gender (0.20 , 0.13 and 0.08) respectively while APTT there was significant difference with management ,complication and gender p. value was (0.01 , 0.03 and 0.01 respectively) .The mean ± SD of fibrinogen level was 136 ± 20.7 ,the mean ± SD of fibrinogen level in male was 137.4 ± 20.6mg/dl and in female was 135.22 ± 20.9 mg/dl. The present study show the insignificant correlation among gender p-value was (0.594). The frequency of duration of disease in group less than 5 years was (34%), in 5-10 years was (41%) and in group more than 10 years was (25%). Statistically insignificant differences between fibrinogen level and duration of disease were observed p-value (0.776), there was insignificant difference between fibrinogen level and different age group p. value (0.66). The mean of D-dimer levels is (1309.3 ± 324.1mg /ml). CONCLUSION: The present study show that shortened prothrombin time, activated partial thromboplastin time, shortened PT and APTT might be useful haemostatic markers in diabetic patients, especially in those at high risk for thrombotic complications. The Mean of plasma fibrinogen level in patient with type II diabetics mellitus were136.3mg/dl, insignificant correlation with Fibrinogen levels with age, gender and duration of disease. The D. Dimer level show significant increase.

Background γ′ fibrinogen is an alternatively-spliced fibrinogen variant that displays different coagulation parameters in vitro than the major form of fibrinogen. Purified γ′ fibrinogen has slower clotting kinetics than unfractionated fibrinogen, but forms clots that are stronger and resistant to fibrinolysis. However, these properties have only been investigated in human populations in a limited number of studies. We therefore performed a retrospective analysis to test the hypothesis that γ′ fibrinogen levels influence coagulation in vivo. Methods In the present study, we utilized blood samples that were collected from traumatic brain injury patients to probe the relationship between γ′ fibrinogen levels and traditional coagulation parameters. Results The results show that the levels of γ′ fibrinogen were inversely associated with clotting kinetics, indicated by a shortened INR. In addition, the levels of γ′ fibrinogen were associated with stronger clots by thrombelastography. However, these changes were not associated with significant changes in hemorrhage progression. Conclusions These findings verify that γ′ fibrinogen properties observed in purified systems result in similar properties in a clinical setting, and may affect coagulation.

Background. Hyperfibrinogenemia plays a crucial role in the coagulation cascade leading to the formation of clots. It is involved in the process of platelet aggregation, primary haemostasis, and leukocyte-endothelial cell interactions. The aim of our study was to assess the correlations between fibrinogen concentration and particular risk factors for vascular diseases and atherosclerotic changes in stroke patients. Methods. The study group consisted with 94 patients with acute ischaemic stroke with normo- or hyperglycaemia and normoor hyperlipidemia. 21 healthy subjects served as a control group. Fibrinogen level, HbA1c, and lipid profile were measured in all patients. Using a flow cytometer, we assessed CD61 positive microparticles which were defined as platelet-derived microparticles (PDMPs). The level of sP-selectin in serum was measured using the ELISA method. Results. A significant positive correlation was observed between fibrinogen concentration and sP-selectin (p = 0.001), HbA1c (p < 0.05) level, and percentage of PDMPs (p < 0.05) in the study patients. Furthermore, we noticed a significant negative correlation between fibrinogen concentration and the level of HDL (p < 0.05). No correlation was observed between fibrinogen and TC, LDL and TG levels. Conclusions and clinical implications. Our findings suggest that an elevated fibrinogen level may represent a marker of prothrombotic condition exacerbated in the state of hyperglycaemia and activation of platelets and endothelial cells. This suggests an important role played by fibrinogen in the process of thrombogenesis.

Severe COVID-19 illness is associated with intense inflammation, leading to high rates of thrombotic complications that increase morbidity and mortality. Markedly elevated levels of D-dimer with normal fibrinogen levels are the hallmark laboratory findings of severe COVID-19- associated coagulopathy. Prophylaxis against venous thromboembolism is paramount for all hospitalized patients, with more aggressive prophylaxis and screening recommended for patients with D-dimer levels above 3.0 μg/mL. Point-of-care ultrasonography is the imaging method of choice for patients at high risk, as it entails minimal risk of exposing providers to the virus.

To retrospectively analyze the relationship between fibrinogen levels and outcomes in poor-grade aneurysmal subarachnoid hemorrhage (aSAH).We recruited 66 patients with poor-grade aSAH who were treated by neurosurgical clipping between January 2010 and December 2015. Serum samples were taken immediately on admission. Baseline information, complications, and outcomes at 6 months were recorded. Univariate and multivariate logistic regression analyses were used to explore the relationship between fibrinogen levels and clinical outcomes.Nineteen men and 47 women were included; the average age was 57.2 years. The median of the admission serum fibrinogen level was 3.3 g/L. Of the 66 patients, 18 had died by 6 months after initial hemorrhage, whereas 48 patients survived. Multivariate analyses showed that Hunt and Hess grade V (odds ratio [OR], 3.89; 95% confidence interval [CI], 1.06-14.20; P = 0.04) and admission serum fibrinogen level2.5 g/L (OR, 6.15; 95% CI, 1.67-22.67; P = 0.006) were significantly associated with 6-month mortality. In addition, admission serum fibrinogen level was negatively correlated with delayed cerebral ischemia, and admission serum fibrinogen level2.5 g/L (OR, 3.86; 95% CI, 0.99-15.09; P = 0.05) was also significantly associated with delayed cerebral ischemia.Patients with poor-grade aSAH with reduced admission fibrinogen level have a higher risk of delayed cerebral ischemia and 6-month mortality compared with those without. The admission serum fibrinogen level might be useful as a predictor and treatment target in patients with poor-grade sSAH who have undergone surgical treatment.

Background and Objective The use of fibrinogen concentrate to treat or prevent major bleeding with regard to potential adverse reactions has not been free of controversy. Our objective was to perform a post-authorization safety study to describe the use of Clottafact® (LFB Biomedicaments) fibrinogen concentrate in real-life medical practice in Mexico. Methods This was a prospective, observational study that collected and evaluated information between January 2017 and June 2019 related to suspected serious adverse reactions (SUSARs) during and after Clottafact® infusion. Results Information from 40 subjects was analyzed; 43% were women (n = 17), mean age was 39.05 ± 26.8 years (range 0–91 years). The medical specialties included in this analysis were cardiac surgery − 52.5% of the cases, gynecology/obstetrics − 17.5%, general surgery and orthopedics − 12.5% each, and hematology and neurosurgery − 2.5%, respectively. Mean plasma fibrinogen levels before and after Clottafact® infusion were 2.58 g/L and 4.02 g/L; p = 0.001, respectively. The mean Clottafact® dose was 2.20 ± 0.77 g. One patient presented SUSARs (dry mouth and dysgeusia) with drug administration, which ceased after treatment discontinuation. Conclusions In this real-life post-marketing study, the safety profile of Clottafact® was very similar to previous reports. Thus, Clottafact® shows a favorable safety profile in clinical practice.

Objective The ROTEM sigma whole blood viscoelastic test uses different technology than the former delta model. Existing ROTEM based algorithms use cutoff values based on the delta model, and cannot be applied to the sigma model. The authors tested sensitivity and specificity of ROTEM sigma parameters to detect specific hemostatic deficiencies and established cutoff values with the aim of developing a treatment algorithm. Design Prospective observational evaluation of diagnostic accuracy. Setting This study was performed in a tertiary center. Participants Blood samples for standard laboratory tests (SLTs) and ROTEM sigma analysis were obtained from 14 healthy volunteers and 35 patients showing various hemostatic disorders (isolated factor deficiencies, von Willebrand's disease, thrombocytopenia, hypofibrinogenemia, hyperfibrinogenemia, and patients undergoing cardiac surgery). Intervention Correlation coefficients were calculated between SLTs and ROTEM parameters in the extrinsic pathway activation, intrinsic pathway activation, and extrinsic pathway activation with platelet inhibition tests. Receiver operator characteristics defined the values of ROTEM parameters, which best predict plasma fibrinogen level measured by Clauss method 37 seconds and 1.5 times the upper normal limit. Measurement and Main Results The combination of FIBTEM A5 ≤12 mm and EXTEM A5 ≤44 mm identified a fibrinogen level 80 seconds had a 25.0% sensitivity and a 100% specificity for a PT 204 seconds showed a sensitivity of 75.0% and a specificity of 97.4% for an aPTT >37 and a sensitivity of 100% and a specificity of 80.0% for an aPTT >55 seconds. Conclusion The authors present the first ROTEM sigma-based algorithm for the treatment of coagulopathic bleeding. The algorithm uses parameters with optimal sensitivity and specificity for critical values of SLTs determined from a heterogenous group of donors.

One of the most common manifestations in HIV infected patients are hematological. Few studies on these manifestations have been conducted in Romania and worldwide. Anemia and infections occur frequently among people living with HIV and reflect the immune suppression of the host. Besides, the etiology of anemia in HIV infection often remains unclear. Therefore, C Reactive Protein (CRP) and fibrinogen can be used as markers of the degree of immune suppression. It is noteworthy that anti-anemic therapies may accelerate the progression of HIV disease. Primary infection or reactivation of known or unknown pathogens is still a major concern associated with blood transfusions and possibly lead to a reduced prognosis. Existing data suggest that severe anemia is one of the main factors. Chronic inflammation and increased hemostasis in HIV-infected persons are thought to be a consequence of viral replication or persistence and it is associated with poor prognostic in HIV-infected patients. Whether low levels of viremia predispose to increased inflammation is unclear. We investigated the relationship between anemia, inflammatory markers, and blood transfusions. The present study is an effort to evaluate correlation as well as the association between inflammatory markers and blood products administration in HIV/AIDS patients.

Background: Malignancies, especially lymphoma, are a common cause of adult secondary HLH and an independent risk factor for the prognosis of HLH patients. Methods: Patients with lymphoma or lymphoma-associated phagocytic syndrome (LAHS) admitted to Beijing Friendship Hospital from January 2016 to December 2020 were enrolled in this study. Findings: In total, there were 348 lymphoma patients, 104 with LAHS and 244 without LAHS. The pathological type of non-LAHS was dominated by B-cell lymphoma, while LAHS was T/NK-cell lymphoma predominantly (p

Aim of the study Subconjunctival hemorrage (SCH) is a frequent bleeding manifestation and a common cause of visits to the primary care. Trauma in young patients and vascular damage such as hypertension in the elderly are the most common causes of SCH and the prevalence of hematological diseases is less than 1%. We aimed to evaluate the prevalence of congenital or acquired bleeding disorders in patients with once or recurrent SCH. Methods used to conduct the study It is a retrospective study and included fifty-two patients with SCH whose etiologic factor was not detected. Hemostatic tests were studied in 52 patients (25 male and 27 females). All patients included were evaluated for congenital or acquired bleeding disorder and SCH with once and those with 2 or more were compared for the laboratory results. Results of the study Type I von Willebrand disease (vWD) was diagnosed in one patient with recurrent SCH and one patient with single SCH (3.8%). The prevalence of patients with type 1 vWD in the study was not statistically significant when compared with the frequency of vWD in the normal population. Fibrinogen level was found to be statistically higher in patients who had SCH once than those who had recurrent SCH. But fibrinogen level was in normal range in all patients. Conclusions drawn from the study and clinical implications There was no increase in the incidence of congenital or acquired bleeding disorder in SCH compared to normal population. Fort this reason, it was thought there was no need for evaluation for bleeding disordes in spontaneous SCH.

Resumen Objetivo: Encontrar una relación entre los niveles de proteína C reactiva (PCR) y fibrinógeno, y la extensión de la aterosclerosis en el síndrome coronario agudo. Métodos: Estudio observacional prospectivo, en el que se incluyeron 873 pacientes con síndrome coronario atendidos en un hospital entre 2016 y 2018. Se analizaron niveles de PCR y fibrinógeno, marcadores metabólicos y extensión de la aterosclerosis coronaria. Resultados: No se halló correlación positiva entre los niveles de PCR y fibrinógeno y los marcadores metabólicos, así como tampoco con enfermedad de uno, dos y tres vasos (p 0,829; p 0,810). Conclusiones: Los niveles sanguíneos de PCR y fibrinógeno se relacionan con la tasa de eventos cardiovasculares, pero no se ha podido demostrar que exista relación entre estos y la severidad de la aterosclerosis coronaria. Abstract Objective: To determine whether there is a relationship between C - reactive protein and fibrinogen levels and the extent of atherosclerosis in acute coronary syndrome. Methods: A prospective observational study was conducted that include 873 patients with coronary syndrome treated in a hospital between the years 2016 and 2018. An analysis was made that included C - reactive protein and fibrinogen levels, metabolic markers, extent of coronary atherosclerosis. Results: No positive correlation was found between the C - reactive protein and fibrinogen levels and the metabolic markers, nor with one, two, or three vessel disease (P=.829; P=.810). Conclusions: Although blood C-Reactive Protein and fibrinogen levels are associated with the rate of cardiovascular events, this study was unable to demonstrate whether there is a relationship between these and the severity of the coronary atherosclerosis.

Elevated plasma fibrinogen is associated with tumor progression and poor outcomes in several cancers. However, no studies have demonstrated the prognostic value of hyperfibrinogenemia in the setting of autologous hematopoietic stem cell transplantation (ASCT). We retrospectively reviewed 104 patients who were diagnosed with malignant lymphoma (ML) or multiple myeloma (MM) and underwent ASCT in our institution between 2007 and 2018. The patients included 63 men and 41 women with a median age of 58 years (range, 24-70 years). Forty-seven patients were diagnosed with ML, and 57 patients were diagnosed with MM. The median follow-up period was 59 months. The median pretransplant plasma fibrinogen levels were 336 mg/dL in ML patients and 320 mg/dL in MM patients. The Kaplan-Meier method revealed that patients with pretransplant hyperfibrinogenemia had a significantly shorter 5-year overall survival (OS) than those without hyperfibrinogenemia (5-year OS: 34.3% vs 81.0%, P .001). Among 27 patients with diffuse large B cell lymphoma, patients with pretransplant hyperfibrinogenemia (n = 12) had a significantly shorter OS than those without hyperfibrinogenemia (n = 15) (5-year OS: 40.0% vs 80.2%, P = .006). Among 57 MM patients, there was no significant difference in the 5-year OS between the high-fibrinogen group and the low-fibrinogen group (5-year OS: 77.1% vs 50.4%, P = .17). Our study suggested that pretransplant hyperfibrinogenemia was associated with a poor survival in patients with lymphoma who underwent ASCT. Because our results are based on a small-sized analysis, further large-scale prospective studies are warranted to verify this conclusion.

Myocardial infraction (AMI) is an irreversible myocardial injury and necrosis caused by serious and long-term ischemia. It is generally seen in middle aged men with high risk factors for coronary artery disease. Only 4% of patients with AMI are under 40 years of age. This was a cross sectional study conducted at AL SHAB hospital, Khartoum, Sudan, aimed to estimate the fibrinogen level among Sudanese patients with myocardial infraction. 50 patients attending Alshab Hospital and diagnosed with MI used as a case group and 50 apparently healthy individuals with no history of MI were selected as control group. 1.8 ml of blood samples has been collected in sodium citrate anticoagulant container for measurement of fibrinogen level by clauss method in coagulometer device. It is clearly significant increase in fibrinogen level in myocardial infraction patient (p.value 0.000). In addition, the prothrombin time and gender were insignificantly differences in (AMI) patients. In the other hand, age and smoking significantly increased as risk factor in myocardial infraction. This study concluded that fibrinogen level was significantly increased in Sudanese patients with myocardial infraction. Keywords: Myochardial Infraction, Fibrinogen, Prothrombin Time, Coagulometer

Background: We investigated the prognostic value of preoperative fibrinogen levels in hepatocellular carcinoma patients receiving liver transplantation by building a scoring model for predicting tumor recurrence. Methods: Cox regression analysis was used to identify factors that predicted tumor recurrence, and a scoring model was generated by assigning a value of 0 or 1 to each independent risk factor. The cut-off value for fibrinogen was determined by receiver operating characteristic curve analysis. Results: Preoperative fibrinogen concentration was significantly higher in patients with vs. without tumor recurrence (3.27 g/L vs. 2.34 g/L, P 400 vs. ≤400 ng/mL plasma alpha-fetoprotein concentration (3.43 g/L vs. 2.76 g/L, P = 0.007). The 5-year disease-free survival rate was significantly lower for patients with elevated (≥2.68 g/L) vs. normal (3 tumor nodules, and elevated fibrinogen concentration were independent risk factors for tumor recurrence. A scoring model based on these risk factors predicted recurrence with a sensitivity of 68.3% and a specificity of 87.5%. Conclusions: Elevated preoperative plasma fibrinogen concentration is associated with tumor recurrence in HCC patients after liver transplantation. A new scoring model predicted recurrence with good sensitivity and specificity. Keywords: Liver transplantation (LT), Hepatocellular carcinoma (HCC), Scoring model, Recurrence, Fibrinogen concentration

Background Viscoelastic coagulation testing is increasingly used to diagnose trauma-induced coagulopathy. Two fully automated analysers, TEG 6s and ROTEM Sigma, were launched recently. No previous studies have compared these devices in trauma paients. Objective The aim of this study was to evaluate whether both fully automatic devices deliver comparable results. Design Prospective observational study. Setting Level one trauma centre from August 2017 to September 2018. Patients A total of 105 blood samples from 67 trauma patients were analysed simultaneously on TEG 6s and ROTEM Sigma. Main outcome measures TEG 6s assays kaolin (CK), RapidTEG (CRT), kaolin with heparinase (CKH) and functional fibrinogen were compared with ROTEM Sigma assays INTEM, EXTEM, HEPTEM and FIBTEM. TEG 6s functional fibrinogen level was compared with plasma fibrinogen concentration, measured using the Clauss method. Correlations were classified as weak (Spearman correlation coefficient 0.20 to 0.39), moderate (0.40 to 0.59), strong (0.60 to 0.79) or very strong (≥0.80). Results The TEG 6s parameters reaction time, kinetic time and α-angle (CK, CRT and CKH assays) mostly showed strong correlations with the corresponding ROTEM parameters clotting time, clot formation time and α-angle (INTEM, EXTEM and HEPTEM assays). The exceptions were CRT reaction time vs. EXTEM clotting time, and CK α-angle vs. INTEM α-angle, which correlated moderately. Absolute values for many of these parameters showed significant differences between the two devices. Very strong correlations and similar absolute values were observed between TEG 6s maximum amplitude (CRT, CK and CKH assays) and ROTEM maximum clot firmness (EXTEM, INTEM and HEPTEM assays). Correlations were also very strong for functional fibrinogen maximum amplitude vs. FIBTEM maximum clot firmness and functional fibrinogen level vs. Clauss fibrinogen concentration, but absolute values were significantly different. Conclusion Strong to very strong correlations were observed between corresponding TEG 6s and ROTEM Sigma parameters. However, absolute values showed significant differences for most of the measurements.

Bleeding is the most common clinical symptom and the leading cause of death in patients with primary immune thrombocytopenia (ITP). Our research intends to verify the role of fibrinogen levels as independent determinants of bleeding. We retrospectively analyzed the relationship between fibrinogen levels and bleeding events in 463 patients. Additionally, we confirmed the impact of fibrinogen level on clot firmness in 25 patients via thrombelastography (TEG). Fibrinogen levels (median and inter-quartile range, IQR) were significantly different (

Objectives To assess whether preoperative plasma fibrinogen is able to predict severe post-tonsillectomy haemorrhage. Study design Retrospective chart review. Methods We included 456 patients who underwent tonsillectomy between 2008 and 2013. Preoperative plasma fibrinogen levels (PFL) were assessed in patients who developed severe bleeding requiring surgical revision under general anesthesia compared to those with uneventful postoperative courses. Results 414 (90.8%) had no severe post-tonsillectomy haemorrhage. In contrast, 42 (9.2%) patients needed surgical hemostasis. PFL were significantly higher (P = .023) in patients with a severe bleeding. Univariate Cox-regression analysis revealed that elevated preoperative fibrinogen represents a significant worse (P = .003; HR 2.66; 95% CI 1.38-5.10) prognostic factor for postoperative bleeding. Even at multivariable analysis, increased PFLs were a significantly worse prognostic factor for post-tonsillectomy haemorrhage (P = .016; HR 15.4; 95% CI 0.01-0.6). High preoperative PFL was associated with significantly higher risk for post-tonsillectomy haemorrhage within the first 31 days after surgery (65% vs 90%; P = .002). Moreover, accurate negative predictive value (NPV) of 95.1% pointed out that PFL could be used as a reliable preoperative screening marker. Conclusions Elevated PFL represents an independent worse prognostic factor for severe bleeding after tonsillectomy and could be helpful to identify patients at higher risk for PTH.

Background and Purpose— We aimed to thoroughly investigate the relationship between early fibrinogen depletion and symptomatic intracranial hemorrhage (sICH) in patients receiving reperfusion therapy including intravenous thrombolysis (IVT) with or without endovascular thrombectomy (EVT). Methods— This study included 1135 stroke patients with baseline and follow-up fibrinogen levels at 2 hours after the beginning of alteplase infusion for those with IVT only or immediately after the end of EVT for those with combined IVT and EVT. Patients received alteplase up to 9 hours after the onset or on awakening based on automated perfusion imaging. sICH was ascertained using ECASS II (The Second European-Australasian Acute Stroke Study) criteria. Δfibrinogen was calculated as follow-up fibrinogen minus baseline fibrinogen. Results— In patients with IVT only, baseline fibrinogen level was 3.36±0.94 g/L and decreased to 2.47±0.80 g/L at 2 hours after the beginning of alteplase infusion. In patients with IVT followed by EVT, baseline fibrinogen level was 3.35±0.82 g/L and decreased to 2.52±0.83 g/L immediately after the end of EVT. sICH was observed in 44 (3.9%) patients. The extent of Δfibrinogen was associated with sICH in patients with IVT only (odds ratio, 1.929; 95% CI, 1.402–2.654; P P =0.012). Conclusions— An early decrease in fibrinogen levels was related to sICH after reperfusion therapy with alteplase. More fibrin-specific thrombolytic agents are warranted to be tested in acute ischemic stroke patients. Clinical Trial Registration— URL: https://www.clinicaltrials.gov . Unique identifier: NCT03367286.