Blood Coagulation, Fibrinolysis and Cellular Haemostasis
Schattauer GmbH
Fibrinogen measurement in cardiac surgery with cardiopulmonary bypass: Analysis of repeatability and agreement of Clauss method within and between six different laboratories
Cristina Solomon
1
Department of Anesthesiology and Intensive Care, Salzburg University Hospital, SALK, Salzburg, Austria
2
CSL Behring, Marburg, Germany
3
Ludwig Boltzmann Institute for Experimental and Clinical Traumatology and AUVA Research Centre, Vienna, Austria
,
Ekaterina Baryshnikova
4
Department of Cardiothoracic and Vascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, Milan, Italy
,
Armando Tripodi
5
Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Department of Clinical Sciences and Community Health, Università degli Studi di Milano and IRCCS Cà Granda Maggiore Hospital Foundation, Milan, Italy
,
Christoph J. Schlimp
3
Ludwig Boltzmann Institute for Experimental and Clinical Traumatology and AUVA Research Centre, Vienna, Austria
,
Herbert Schöchl
3
Ludwig Boltzmann Institute for Experimental and Clinical Traumatology and AUVA Research Centre, Vienna, Austria
6
Department of Anesthesiology and Intensive Care, AUVA Trauma Hospital of Salzburg, Austria
,
Janne Cadamuro
7
Department of Laboratory Medicine, University Hospital of Salzburg, Salzburg, Austria
,
Dag Winstedt
8
Department of Anaesthesiology and Intensive Care, Skåne University Hospital and Lund University, Lund, Sweden
,
Lars Asmis
9
Unilabs, Coagulation Laboratory of Unilabs, Zurich, Switzerland
,
Marco Ranucci
4
Department of Cardiothoracic and Vascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, Milan, Italy
› InstitutsangabenFinancial support: The study was supported by an unrestricted research grant from CSL Behring.
Plasma fibrinogen concentration is important for coagulopathy assessment, and is most commonly measured using the Clauss method. Several factors, including device type and reagent, have been shown to affect results. The study objective was to evaluate performance and repeatability of the Clauss method and to assess differences between measurements performed during and after cardiopulmonary bypass (CPB), by testing plasma samples from patients undergoing cardiac surgery with CPB. Samples were collected from 30 patients before surgery, approximately 20 minutes before weaning from CPB, and 5 minutes after CPB and protamine. Fibrinogen concentration was determined using the Clauss method at six quality-controlled specialised laboratories, according to accredited standard operating procedures. Regarding within-centre agreement for Clauss measurement, mean differences between duplicate measurements were between 0.00 g/l and 0.15 g/l, with intervals for 95% limits of agreement for mean Bland-Altman differences up to 1.3 g/l. Regarding between-centre agreement, some mean differences between pairs of centres were above 0.5 g/l. Differences of up to ∼2 g/l were observed with individual samples. Increased variability was observed between centres, with inter-class correlation values below 0.5 suggesting only fair agreement. There were no significant differences in fibrinogen concentration before weaning from CPB and after CPB for most centres and methods. In conclusion, considerable differences exist between Clauss-based plasma fibrinogen measured using different detection methods. Nevertheless, the similarity between measurements shortly before weaning from CPB and after CPB within centres suggests that on-pump measurements could provide an early estimation of fibrinogen deficit after CPB and thus guidance for haemostatic therapy.
Keywords
Blood coagulation tests -
clinical laboratory techniques -
fibrinogen -
nephelometry and turbidimetry -
patient care management
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