Despite its clinical relevance, low fibrinogen is often unrecognized or under-recognized in acute care settings.2,3
Delays in diagnosis and treatment may result from:

  • Unnoticed or undiagnosed manifestations1
  • Limited access to rapid diagnostic tools3
  • Coagulation test whose sensitivity varies by mutation, reagents, and techniques4

Timely identification of CFD enables proactive fibrinogen replacement to reduce bleeding risk during trauma, invasive procedures, and obstetric events, while also addressing the paradoxical risk of thrombosis. Given the rarity and variability of these disorders, standardized diagnostic strategies are essential for optimal outcomes.4

Method
Benefits
  • Simple initial screening
  • Detects clotting abnormalities when fibrinogen is absent
Challenges
  • Low sensitivity for qualitative defects 
  • May appear normal in mild cases
Benefits
  • Prolonged in severe quantitative deficiencies
  • Confirms global clotting impairment
Challenges
  • Variable in mild disorders
  • Unreliable for dysfibrinogenemia
Benefits
  • Highly sensitive for both quantitative and qualitative defects
  • Good for detecting dysfibrinogenemia
Challenges
  • Cannot distinguish defect type
  • Influenced by reagents and technique
Benefits
  • Accurate quantitative measurement
  • Established clinical standard
Challenges
  • Time-consuming
  • Limited functional insight (does not assess clot strength)
Benefits
  • Rapid point-of-care results (10–20 mins)
  • Guides targeted therapy
  • Correlates with clinical outcomes
Challenges
  • Lack of standardization
  • Requires specialized training
  • Higher cost and limited accessibility
Method Benefits Challenges

Prothrombin Time (PT)4
  • Simple initial screening
  • Detects clotting abnormalities when fibrinogen is absent
  • Low sensitivity for qualitative defects 
  • May appear normal in mild cases

Activated Partial Thromboplastin Time (aPTT)4
  • Prolonged in severe quantitative deficiencies
  • Confirms global clotting impairment
  • Variable in mild disorders
  • Unreliable for dysfibrinogenemia

Thrombin Time (TT)4
  • Highly sensitive for both quantitative and qualitative defects
  • Good for detecting dysfibrinogenemia
  • Cannot distinguish defect type
  • Influenced by reagents and technique

Clauss Method5
  • Accurate quantitative measurement
  • Established clinical standard
  • Time-consuming
  • Limited functional insight (does not assess clot strength)

Viscoelastic Testing (ROTEM, TEG, QUANTRA)5
  • Rapid point-of-care results (10–20 mins)
  • Guides targeted therapy
  • Correlates with clinical outcomes
  • Lack of standardization
  • Requires specialized training
  • Higher cost and limited accessibility

 QUANTRA, quantitative rapid assessment; ROTEM, rotational thromboelastrometry; TEG, thromboelastography.

Once a diagnosis of CFD has been made, management of the condition becomes critical.

Managing CFD
Managing CFD

Get more information about CFD, management options, and treatment advancements.

Stay informed
Stay informed

References

  1. May JE, Wolberg AS, Lim MY. Disorders of fibrinogen and fibrinolysis. Hematol Oncol Clin North Am. 2021;35(6):1197-1217.
  2. Grottke O, Mallaiah S, Karkouti K, Saner F, Haas T. Fibrinogen supplementation and its indications. Semin Thromb Hemost. 2020;46(1):38-49.
  3. Rossaint R, Afshari A, Bouillon B, et al. The European guideline on management of major bleeding and coagulopathy following trauma: sixth edition. Crit Care. 2023;27(1):80.
  4. de Moerloose P, Neerman-Arbez M. Congenital fibrinogen disorders. Semin Thromb Hemost. 2009;35:356-366.
  5. Ikić V. Fibrinogen and bleeding in adult cardiac surgery: a review of the literature. Surgeries. 2021;2:409–436.