Laboratory

Evaluation of
Fibrinolysis
Donna Therese M. Taguinod, RMT, MPH

Laboratory Tests to Evaluate

Fibrinolysis:
1. Whole blood clot lysis time

2. Protamine sulfate dilution test

3. Ethanol gelation test

4. Latex FDP test

5. Latex D-Dimer assay

Whole Blood Clot Lysis Time

Whole blood (No Anticoagulant)
should remain clotted and should not
show significant lysis for 48 hours at
37C
Positive in severe fibrinolysis

Euglobulin Lysis Time:

Is used as a screening
fibrinolytic activity.

test

for

The euglobulin fraction of plasma

consists of Fibrinogen, plasminogen,
and fibrinolytic activators

The euglobulin fraction is precipitated

with 1% acetic acid and resuspended
in a borate solution. Euglobulins are
clotted by the addition of thrombin (5
units/mL).
The
resulting
clot
is
incubated (37C) and the time of lysis is
obtained.

Euglobulin Lysis Time:

The clot should remain intact for 2-4
hours
Interpretation:

Clot lysis in < 2hours is indicative of

abnormal fibrinolytic activity and
decrease in fibrinogen
A prolonged time > 4 hours is
caused
by
a
decrease
in
plasminogen or activator.

Note: It does not detect FDPs

Protamine Sulfate Dilution Test

When protamine is added in plasma, it
displaces the secondary (smaller)
degradation products from fibrin
monomer and primary (larger) FDP will
polymerize
spontaneously
(paracoagulation)
Normally, no gel formation

(+) result : gel formation = DIC,

pulmonary embolism, thrombolytic
therapy

Ethanol Gelation Test

Less sensitive but more specific than
protamine sulfate
50% solution ethanol will polymerize
any fibrin monomers resulting to gel
formation

Fibrinogen Levels
Quantitated by various methods including
precipitation, denaturation, turbidimetry or
fibrin clot density method, coagulable
proteins assays, immunological assays and
modified thrombin time.
NV: 200-400 mg/dL
Decrease in liver disease or consumption of
fibrinogen owing to accelerating
intravascular clotting.
Fibrinogen titer may be useful:
Normal = 1:128 to 1:256

Abnormal = <1:64

Latex FDP Assay

Latex particles are coated with antibodies to
FSPs.
If significant level of the fragments are in the
serum, agglutination will occur.
DIC

Pulmonary embolism
DVT (Deep vein Thrombosis)
Myocardial infarction
Pre-eclampsia

Latex D-dimer Assay:

Measures specific cross-linked D-dimer
fragments from degradation of stabilized
fibrin clots by plasmin.

D-dimers are evidence of intravascular

fibrin formation.
Monoclonal antibodies to D-dimers are
attached to latex particles causing
agglutination if D-dimers are present
Specimen of choice: fresh citrated blood
Useful in the diagnosis of DIC

NV: <200 mg/dL

Plasminogen Assay:
Chromogenic or fluorogenic substrate
allow functional
quantitation
of
plasminogen.

Fibrinopeptides A or B Assay:
Fibrinogen
fragments
can
measured by radio-immunoassay.

be

Protein C (PC) and Protein S

(PS) and AT III assays
Can all be measured for a degree of
activity with chromogenic assays or
with immunoassays to measure the
concentration of the molecule (i.e
antigen).

Activated Protein C Resistance

(APCR)
Is the inability of APC to prolong
clotting tests when added to the APTT.
This phenomenon is characteristic of a
genetic thrombotic disorder known as
factor V Leiden.