Fibrinogen Degradation Products


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Related to Fibrinogen Degradation Products: Fibrin Split Products

fibrinogen

 [fi-brin´o-jen]
a high-molecular-weight protein in the blood plasma that by the action of thrombin is converted into fibrin; called also factor i. In the clotting mechanism, fibrin threads form a meshwork for the basis of a blood clot. Most of the fibrinogen in the circulating blood is formed in the liver. Normal quantities of fibrinogen in the plasma vary from 100 to 700 mg per 100 ml of plasma.

Commercial preparations of human fibrinogen are used to restore blood fibrinogen levels to normal after extensive surgery, or to treat diseases and hemorrhagic conditions that are complicated by afibrinogenemia.
fibrinogen degradation products fragments of fibrinogen or fibrin degraded by plasmin, which are found in the serum and urine of patients with disseminated intravascular coagulation (DIC) and in the urine of patients who have had renal transplants.

Fibrinogen Degradation Products

Synonym/acronym: Fibrin split products, fibrin breakdown products, FDP, FSP, FBP.

Common use

To evaluate conditions associated with abnormal fibrinolytic and fibrinogenolytic activity such as disseminated intravascular coagulation (DIC), deep vein thrombophlebitis (DVT), and pulmonary embolism (PE).

Specimen

Plasma (1 mL) collected in a completely filled blue-top (3.2% sodium citrate) tube. If the patient’s hematocrit exceeds 55%, the volume of citrate in the collection tube must be adjusted.

Normal findings

(Method: Latex agglutination)
Conventional UnitsSI Units (Conventional Units × 1)
Less than 5 mcg/mLLess than 5 mg/dL

Description

This coagulation test evaluates fibrin split products or fibrin/fibrinogen degradation products (FDPs) that interfere with normal coagulation and formation of the hemostatic platelet plug. As thrombin initiates the formation of the fibrin clot, it also activates the fibrinolytic system to limit the size of clot formation and prevent venous occlusion. The d-dimer is specific to secondary fibrinolysis because it detects the disintegration of fibrin rather than fibrinogen. The FDP test detects degradation products of primary fibrinolysis generated by the action of thrombin on fibrinogen as well as degradation products of secondary fibrinolysis by the action of plasmin on fibrin. The two tests together can be useful for differentiation and treatment of suspected cases of fibrinolysis. In the case of primary fibrinolysis, the FDP will be positive while the d—dimer is normal. In DIC, or secondary fibrinolysis, both will be elevated. FDPs are normally cleared rapidly from circulation, however increased circulating levels can interfere with hemostasis by interfering with fibrin polymerization and adhering to platelet cell membranes thereby inhibiting their normal function.

This procedure is contraindicated for

    N/A

Indications

  • Assist in the diagnosis of suspected DIC
  • Evaluate response to therapy with fibrinolytic drugs
  • Monitor the effects on hemostasis of trauma, extensive surgery, obstetric complications, and disorders such as liver or renal disease

Potential diagnosis

Increased in

  • DIC (FDP can be positive in a number of conditions in which the coagulation system has been excessively stimulated as a result of tissue injury and fibrin and/or fibrinogen is being degraded by plasmin)
  • Excessive bleeding (clot formation related to depletion of platelets and clotting factors will stimulate fibrinolysis and increase circulation of fibrin breakdown products)
  • Liver disease (related to decreased hepatic clearance)
  • Myocardial infarction (FDP can be positive in a number of conditions in which the coagulation system has been excessively stimulated as a result of tissue injury and fibrin and/or fibrinogen is being degraded by plasmin)
  • Obstetric complications, such as pre-eclampsia, abruptio placentae, intrauterine fetal death (excessive stimulation of the coagulation system; microthrombi are formed and plasminogen is released to dissolve the fibrin clots)
  • Post–cardiothoracic surgery period (FDP can be positive in a number of conditions in which the coagulation system has been excessively stimulated as a result of tissue injury and fibrin and/or fibrinogen is being degraded by plasmin)
  • Pulmonary embolism (FDP can be positive in a number of conditions in which the coagulation system has been excessively stimulated as a result of tissue injury and fibrin and/or fibrinogen is being degraded by plasmin)
  • Renal disease (FDP can be positive in a number of conditions in which the coagulation system has been excessively stimulated as a result of tissue injury and fibrin and/or fibrinogen is being degraded by plasmin)
  • Renal transplant rejection

Decreased in

    N/A

Critical findings

    N/A

Interfering factors

  • Traumatic venipunctures and excessive agitation of the sample can alter test results.
  • Drugs that may increase fibrin degradation product levels include heparin and fibrinolytic drugs such as streptokinase and urokinase.
  • The presence of rheumatoid factor may falsely elevate results with some test kits.
  • The test should not be ordered on patients receiving heparin therapy.
  • Hematocrit greater than 55% may cause falsely prolonged results because of anticoagulant excess relative to plasma volume.
  • Incompletely filled collection tubes, specimens contaminated with heparin, clotted specimens, or unprocessed specimens not delivered to the laboratory within 1 to 2 hr of collection should be rejected.

Nursing Implications and Procedure

Potential nursing problems

ProblemSigns & SymptomsInterventions
Bleeding (Related to anticoagulant therapy; altered clotting factors; depleted clotting factors)Altered level of consciousness; hypotension; increased heart rate; decreased HGB and HCT; capillary refill greater than 3 sec; cool extremitiesIncrease frequency of vital sign assessment with variances in results; monitor for vital sign trends; administer blood or blood products as ordered; administer stool softeners as needed; monitor stool for blood; encourage intake of foods rich in vitamin K; monitor and trend HGB/HCT; assess skin for petechiae, purpura, hematoma; monitor for blood in emesis, or sputum; institute bleeding precautions (prevent unnecessary venipuncture; avoid IM injections; prevent trauma; be gentle with oral care, suctioning; avoid use of a sharp razor); administer prescribed medications (recombinant human activated protien C; epsilon aminocaproic acid)
Gas exchange (Related to decreased lung tissue perfusion secondary to embolic obstruction; aveolar dead space; increased shunting secondary to alveolar collapse; ventilation perfusion mismatch)Cyanosis; increased respiratory rate; anxiety; restlessness; confusion; irritability; tachycardia; dyspnea; headache; abnormal ABG; lethargy; somnolence; decreased oxygen saturation (less than 90%); adventitious breath sounds (crackles); areas of decreased lung ventilation; cough, hemoptysis, pleuritic pain in the presence of pulmonary infarctMonitor and trend ABG results; monitor respiratory rate and effort; monitor and trend pulse oximetry; monitor and trend vital signs; ensure patient does not cross legs while lying or sitting; assess lung sounds frequently; use pulse oximetry to monitor oxygen saturation; collaborate with physician to administer oxygen as needed; elevate the head of the bed 30 degrees; assess for hypoxia symptoms; administer prescribed anticoagulant therapy
Bleeding (Related to altered clotting factors secondary to anticoagulant therapy)Altered level of consciousness; hypotension; increased heart rate; decreased HGB and HCT; capillary refill greater than 3 sec; cool extremitiesIncrease frequency of vital sign assessment with variances in results; monitor for vital sign trends; administer blood or blood products as ordered; monitor stool for blood; encourage intake of foods rich in vitamin K; monitor and trend HGB/HCT, INR, PT, PTT; ensure that anticoagulant therapy is accurately administered (IV, PO); assess skin for petechiae, purpura, hematoma; monitor for blood in emesis, or sputum; institute bleeding precautions (prevent unnecessary venipuncture; avoid IM injections; prevent trauma; be gentle with oral care, suctioning; avoid use of a sharp razor)
Tissue perfusion (Related to vessel wall injury; blood hypercoagulability)Femoral, popliteal, or small calf vein tenderness, warmth at involved area, pain with leg palpation, edema; it is possible to be asymptomatic if the DVT is located in a distal veinAssess for symptoms of DVT; assess for contributing factors (trauma, recent surgery, smoking, varicose veins, age, venous stasis, obesity, pregnancy, oral contraceptive use); monitor diagnostic test results (d-dimer, ultrasound, impedance plethysmography); monitor and trend coagulation studies (PT, INR, PTT); encourage bedrest with leg elevation; administer prescribed anticoagulant therapy; institute bleeding precautions (avoid IM injections, prevent trauma, be gentle with oral care and suctioning, avoid use of a sharp razor); apply moist heat at affected area; apply leg compression devices as prescribed; prepare for potential adjunct therapy (thrombolytic, vena cava filter, thrombectomy)

Pretest

  • Positively identify the patient using at least two unique identifiers before providing care, treatment, or services.
  • Patient Teaching: Inform the patient this test can assist in diagnosing diseases associated with clotting disorders.
  • Obtain a history of the patient’s complaints, including a list of known allergens, especially allergies or sensitivities to latex.
  • Obtain a history of the patient’s hematopoietic system, any bleeding disorders, symptoms, and results of previously performed laboratory tests and diagnostic and surgical procedures.
  • Note any recent procedures that can interfere with test results.
  • Obtain a list of the patient’s current medications, including anticoagulants, aspirin and other salicylates, herbs, nutritional supplements, and nutraceuticals (see Effects of Natural Products on Laboratory Values online at DavisPlus). Note the last time and dose of medication taken.
  • Review the procedure with the patient. Inform the patient that specimen collection takes approximately 5 to 10 min. Address concerns about pain and explain that there may be some discomfort during the venipuncture.
  • Sensitivity to social and cultural issues, as well as concern for modesty, is important in providing psychological support before, during, and after the procedure.
  • Note that there are no food, fluid, or medication restrictions unless by medical direction.

Intratest

  • Potential complications: N/A
  • Avoid the use of equipment containing latex if the patient has a history of allergic reaction to latex.
  • Instruct the patient to cooperate fully and to follow directions. Direct the patient to breathe normally and to avoid unnecessary movement.
  • Observe standard precautions, and follow the general guidelines in Patient Preparation and Specimen Collection. Positively identify the patient, and label the appropriate specimen container with the corresponding patient demographics, initials of the person collecting the specimen, date, and time of collection. Perform a venipuncture. Fill tube completely. Important note: When multiple specimens are drawn, the blue-top tube should be collected after sterile (i.e., blood culture) tubes. Otherwise, when using a standard vacutainer system, the blue-top tube is the first tube collected. When a butterfly is used, due to the added tubing, an extra red-top tube should be collected before the blue-top tube to ensure complete filling of the blue top tube.
  • Remove the needle and apply direct pressure with dry gauze to stop bleeding. Observe/assess venipuncture site for bleeding or hematoma formation and secure gauze with adhesive bandage.
  • Promptly transport the specimen to the laboratory for processing and analysis. The CLSI recommendation for processed and unprocessed samples stored in unopened tubes is that testing should be completed within 1 to 4 hr of collection.

Post-Test

  • Inform the patient that a report of the results will be made available to the requesting HCP, who will discuss the results with the patient.
  • Depending on the results of this procedure, additional testing may be performed to evaluate or monitor progression of the disease process and determine the need for a change in therapy. Evaluate test results in relation to the patient’s symptoms and other tests performed.
  • Patient Education

    • Instruct the patient to report bleeding from skin or mucous membranes, ecchymosis, petechiae, hematuria, and occult blood.
    • Inform the patient with increased levels of fibrin degradation products of the importance of taking precautions against bruising and bleeding, including the use of a soft bristle toothbrush, use of an electric razor, avoidance of constipation, avoidance of acetylsalicylic acid and similar products, and avoidance of IM injections.
    • Reinforce information given by the patient’s HCP regarding further testing, treatment, or referral to another HCP.
    • Answer any questions or address any concerns voiced by the patient or family.
    • Teach patient that crossing legs increases DVT risk.
  • Expected Patient Outcomes

    • Knowledge
    • States the purpose of anticoagulant therapy as to prevent more clot formation.
    • States understanding that the purpose of heat application to the affected area is to relieve pain and inflammation.
    • Skills
    • Demonstrates proficiency with deep breathing exercises.
    • Demonstrates proficiency in self-administration of ordered anticoagulant therapy.
    • Attitude
    • Complies with the request to maintain bedrest until the HCP deems it is safe to resume activity.
    • Complies with the request to refrain from risky activities to prevent injury

Related Monographs

  • Related tests include aPTT, ALT, alveolar/arterial gradient, angiography pulmonary, AT-III, AST, bilirubin, biopsy liver, blood pool imaging, BUN, coagulation factors, CT cardiac scoring, creatinine, CBC, CK and isoenzymes, CRP, d-dimer, exercise stress test, FDP, fibrinogen, GGT, lung perfusion scan, lung ventilation scan, myoglobin, plasminogen, platelet count, PET heart, procalcitonin, protein S, PT/INR, troponin, US venous Doppler extremity studies, and venography lower extremity studies.
  • Refer to the Hematopoietic System table at the end of the book for related tests by body system.
References in periodicals archive ?
5 g/1, but fibrinogen degradation products remained at the upper limit of normality (40-50 [micro]g/ml).
An increased concentration of fibrinogen degradation products (FDPs) commonly is used in conjunction with other hemostatic test abnormalities to identify patients with disseminated intravascular coagulation (DIC).
DR-70 (FDP) is an in vitro diagnostic test that enables physicians and their patients to effectively monitor and/or detect certain types of cancers by measuring the accumulation of specific breakdown products in the blood called Fibrin and Fibrinogen Degradation Products (FDP).