Acute phase protein (Acute Phase Reactants)
- Acute phase protein is raised in the inflammatory conditions.
- When there is increased in a protein called positive acute phase protein.
- In the case of a decrease in the acute phase protein, is called negative phase protein.
- The acute phase proteins (positive) are protein whose concentration increases in the plasma and after the disease episode is over then it decreases and may become normal.
Fibrinogen (Factor 1)
- The patient blood is needed to prepare plasma.
- The sample is stable for 8 hours at room temperature.
- Can be stored for several months at -20 °C.
- For the evaluation of bleeding disorder.
- If there is excessive bruising.
- In case of bleeding from the gums and nose.
- In case of Bleeding in the GIT and blood in the stool.
- In the case of blood in the urine.
- If there is rupture of the spleen.
- Avoid clot formation.
- Avoid collecting the blood from the heparinized blood vessel.
- Avoid contamination with tissue which contains tissue thromboplastin.
- Avoid contamination with heparin.
- Blood transfusion in the last month may affect the result.
- Diet rich in Omega-3 and Omega-6 fatty acids reduces the level of fibrinogen.
- Oral contraceptives and estrogen increase the level.
- Drugs like anabolic steroids, phenobarbital, streptokinase, valproic acid, and asparaginase.
- This is beta-globulin and is usually absent from the serum.
- It is a fibrillary group of a protein.
- This consists of three pairs of polypeptide chains.
- This is synthesized in the liver. It acts as an acute phase protein.
- When fibrinogen is transfused:
- 50% disappears in 48 hours.
- 75% disappears in 6 days.
- Half-life is 3.5 to 4 days.
- This is an essential protein for blood clot formation. This is a complex protein with enzymatic action is converted into fibrin.
- In the process of clotting, all the fibrinogen in the plasma is converted to fibrin.
- This is part of the common pathway in coagulation.
- Now the serum will be laking fibrinogen.
- The fibrinogen has a major effect on the RBCs sedimentation rate by coating the cells.
- This allows the cells to settle (sediment) faster.
- So increased fibrinogen indicate raised ESR.
- Disseminated intravascular coagulopathy (DIC): In this case, fibrinogen is decreased.
- This is raised by inflammation or tissue injury.
- Snake venom leads to depletion of fibrinogen.
- An elevated level may be seen in:
- Acute infections.
- Myocardial infarction.
- Patients with malignancies.
- Inflammatory conditions like Rheumatoid arthritis and Glomerulonephritis.
- In the case of traumatic injury.
- Patient with a stroke.
- In pregnancy.
- Person smoking cigarettes.
- Patients with peripheral artery disease.
- This is raised in acute and chronic inflammation.
- High level of fibrinogen is associated with increased risk of:
- Coronary heart disease.
- Myocardial infarction.
- Peripheral arterial disease.
- Reduced level of fibrinogen is seen in:
- Patients with liver diseases.
- Consumptive coagulopathy like DIC.
- Malnourished patients.
- In case of a large volume of blood transfusion.
- Source 2
- Newborn = 125 to 300 mg/dL
- Adult = 200 to 400 mg/dL (2 to 4 g/L)
- Source 4
- 200 to 400 mg/dL (2 to 4 g/L)
- Critical value = <100 mg/dL
The increased level is seen in:
- In trauma.
- In coronary heart disease.
- Acute inflammatory condition.
- In cigarettes smoking.
- Maybe increased in thrombosis.
The decreased level is seen in:
- In liver diseases.
- Congenital deficiency.
- In DIC (disseminated coagulopathy).
- In fibrinolysis.
- This is rare and usually inherited as an autosomal recessive trait.
- If the parents do not show the disease but still they can have affected children.
- When 2 carriers of autosomal recessive positive parents have children, each child has a:
- 25% chances to be affected.
- 50% chances to be an unaffected carrier.
- 25% chances to be unaffected and not a carrier.
- There is a severe lake of fibrinogen and blood will not clot.
- Signs and symptoms:
- In the case of afibrinogenemia if fibrinogen level is <0.1 g/L, will have bleeding abnormality from mild to severe.
- This disease is present from birth.
- The first symptom is bleeding from the umbilical cord which will not stop and difficult to stop.
- There may be gastrointestinal bleeding.
- There may be nose bleeding (epistaxis) or bleeding from the oral mucosa.
- There may be bleeding episodes, bruise and poor healing of the wound.
- Female may have excessive menstruation.
- There may be spontaneous abortion.
- There may be CNS hemorrhage.
- Evidence of bleeding in the joints.
- Diagnosis: Following tests are advised:
- Prothrombin time (PT)>
- Activated partial thromboplastin time (APTT).
- Fibrinogen level in the blood.
- Reptilase time.
- Thrombin time.
- Prolonged bleeding tests time and fibrinogen level <0.1 g/L, indicating afibrinogenemia.
- There is abnormal fibrinogen due to a structural abnormality and result in an abnormal function.
- This may be:
- Congenital or Inherited, there is increased risk of bleeding or thrombosis or both in the same patient or family.
- Some of the patients are asymptomatic.
- Prognosis is good. Eventa of thrombosis and bleeding are mild.
- Acquired where the fibrinogen is dysfunctional due to autoimmune diseases or liver diseases, plasma cell dyscrasia or cancers.
- There is more bleeding than thrombosis.
- The prognosis is worse because of liver disease.
- This leads to relatively mild hemorrhage in case of congenital cause.
- Few of these may have a tendency for thrombosis in case of acquired cause.
- Prothrombin time (PT) is prolonged.
- Activated partial thromboplastin (APTT) is also prolonged.
- Thrombin time (TT) is the most sensitive test for dysfibrinogenemia in case of bleeding tendency and may not be prolonged in the case with a tendency for thrombosis.
- Reptilase time is prolonged.
- Critical value is <60 mg/dL.
Value for the layman:
- This is advised when there is a history of bleeding or bruises.
- If the patient has epistaxis.
Possible References Used
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