Proposal of a Fibrinogen Demand Management in Our Emergency Laboratory

• Published in: Indian journal of clinical biochemistry 2022-05, Vol.34 (S1), p.S160
• Main Authors: Laura, Garre Morata, Pablo, Sanchez Gonzalez, Alberto, Perojil Jimenez, Amparo, Martin Alcolea Maria, Luis, Dominguez Rodriguez, Tomas, De Haro Munoz
• Format: Article
• Language: English
• Subjects: Analysis; C-reactive protein; Fibrin; Fibrinogen; Medical care, Cost of
• ISSN: 0970-1915

The increase in the demand of analytical tests beside health care costs associated has revealed the need to improve their management in order to reduce the number of unnecessary tests. In our emergency laboratory, a protocol has been proposed to remove coagulative fibrinogen determination of the "urgent coagulation profile" when it is unnecessary unless it could be requested by the physician. The aim of the study is to determine the number of pathological fibrinogen results that would justify the realization of this demand management. Retrospective study based on the determination of fibrinogen test (coagulative and calculated, Siemens) and C-Reactive Protein (CRP) (Beckman-Coulter) during a period of six months. Data were obtained using LIS Modulab (Werfen[R]). Data analysis were performed using regression analysis (Microsoft Excel). Of a total of 21.950 fibrinogen results, 18.235 (83,1%) were processed urgently. 13.345 (73,2%) determinations presented a pathological result (350 mg/dL): 4,3% due to a fibrinogen deficiency and 68,9% because of high results. Because one cause of the increase of fibrinogen levels is due to acute phase reactant, the results of the CRP were analyzed, so that 89,7% of high fibrinogen results coincide with values of pathological CRP (>5 mg/L). A good concordance of both coagulative and calculated fibrinogen results was obtained, being the linear regression coefficient R = 0.9324. A high percentage of elevated fibrinogen results is associated with high CRP values, showing that fibrinogen is an acute phase reactant. These results could allow us to exclude the coagulative fibrinogen of the "urgent coagulation profile", decreasing significantly the demand for this test besides a drastic reduction in the laboratory's costs. With the good concordance between fibrinogen methods; coagulative assay could be replaced by calculated fibrinogen in the "urgent coagulation profile", without losing analytical information for physicians.