Fibrinogen measurement in cardiac surgery with cardiopulmonary bypass: Analysis of repeatability and agreement of Clauss method within and between six different laboratories

Cristina Solomon; Ekaterina Baryshnikova; Armando Tripodi; Christoph J. Schlimp; Herbert Schöchl; Janne Cadamuro; Dag Winstedt; Lars Asmis; Marco Ranucci

doi:10.1160/TH13-12-0997

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2014; 112(01): 109-117
DOI: 10.1160/TH13-12-0997

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

¹Department of Anesthesiology and Intensive Care, Salzburg University Hospital, SALK, Salzburg, Austria

²CSL Behring, Marburg, Germany

³Ludwig Boltzmann Institute for Experimental and Clinical Traumatology and AUVA Research Centre, Vienna, Austria

,

Ekaterina Baryshnikova

⁴Department of Cardiothoracic and Vascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, Milan, Italy

,

Armando Tripodi

⁵Angelo 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

³Ludwig Boltzmann Institute for Experimental and Clinical Traumatology and AUVA Research Centre, Vienna, Austria

,

Herbert Schöchl

³Ludwig Boltzmann Institute for Experimental and Clinical Traumatology and AUVA Research Centre, Vienna, Austria

⁶Department of Anesthesiology and Intensive Care, AUVA Trauma Hospital of Salzburg, Austria

,

Janne Cadamuro

⁷Department of Laboratory Medicine, University Hospital of Salzburg, Salzburg, Austria

,

Dag Winstedt

⁸Department of Anaesthesiology and Intensive Care, Skåne University Hospital and Lund University, Lund, Sweden

,

Lars Asmis

⁹Unilabs, Coagulation Laboratory of Unilabs, Zurich, Switzerland

,

Marco Ranucci

⁴Department of Cardiothoracic and Vascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, Milan, Italy

› Author Affiliations

Abstract

Summary

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

Full Text

References

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