Photo-Optical Methods Can Lead to Clinically Relevant Overestimation of Fibrinogen Concentration in Plasma Diluted With Hydroxyethyl Starch

Background: Adequate fibrinogen concentration is a crucial component of sufficient perioperative/posttraumatic hemostasis. In major blood loss, large volumes of fluids are being administered, which have been shown to interfere with valid determination of fibrinogen concentration. This may lead to wrong treatment decisions. We studied the variables that cause the discrepancies between measured and true fibrinogen concentrations in samples diluted with volume replacement fluids. Methods: Citrated plasma samples of healthy volunteers were diluted by 30% and 50% with phosphate buffered saline (PBS), hydroxyethyl starch (HES) 10% (200/0.5), or gelatine (GEL). Fibrinogen concentrations of diluted samples were derived from the prothrombin time (PT) and the Clauss method (CLS) was applied. With the latter, several modifications and combinations of detection principles and thrombin reagents were investigated. Values were compared with ‘‘true,’’ that is, calculated values based on the results of undiluted samples f...