ORIGINAL ARTICLESRotational thromboelastography for monitoring of fibrinogen concentrate therapy in fibrinogen deficiencyKalina, Uwea; Stöhr, Hans-Arnolda; Bickhard, Heikea; Knaub, Sigurda; Siboni, Simona Mb; Mannucci, Pier Mb; Peyvandi, FlorabAuthor Information aDepartment of Clinical Research and Development, CSL Behring GmbH, Marburg, Germany bAngelo Bianchi Bonomi Hemophilia and Thrombosis Centre and Luigi Villa Foundation, Department of Medicine and Medical Specialties, University of Milan and IRCCS Maggiore Hospital, Mangiagalli and Regina Elena Foundation, Milan, Italy Received 21 March, 2008 Revised 3 June, 2008 Accepted 2 July, 2008 Correspondence to Dr Uwe Kalina, Department of Clinical Research and Development, CSL Behring GmbH, D-35041 Marburg, Germany Tel: +49 6421 39 5617; fax: +49 6421 39 4663; e-mail: firstname.lastname@example.org Blood Coagulation & Fibrinolysis: December 2008 - Volume 19 - Issue 8 - p 777-783 doi: 10.1097/MBC.0b013e32830ef90c Buy Metrics Abstract To characterize a functional assay for circulating fibrinogen based on rotational thrombelastography. Maximum clot firmness was determined by rotational thrombelastography in normal human plasma pool, fibrinogen-deficient plasma pool, normal whole blood, and individual plasma samples from 17 patients with fibrinogen deficiency. Plasma samples spiked with varying concentrations of exogenous fibrinogen were also measured. Results were compared with enzyme-linked immunosorbent assay and Clauss assay. The impact of sample freezing and filtration and use of cytochalasin D were also investigated. Over the tested range of 0–3 mg/ml added exogenous fibrinogen, the maximum clot firmness standard curve for determination of fibrinogen in plasma pools (n = 7) was linear (r2 = 0.97). Maximum clot firmness was highly linearly correlated both with Clauss assay (r2 = 0.93) and enzyme-linked immunosorbent assay (r2 = 0.95). In unspiked plasma samples from individual patients with fibrinogen deficiency, fibrinogen was undetectable by rotational thromboelastography. By all evaluated methods, the response to spiking with fibrinogen in such samples coincided closely in patients with afibrinogenemia and hypofibrinogenemia. In dysfibrinogenemia, smaller Clauss assay responses to spiking were observed, whereas the enzyme-linked immunosorbent assay response was variable. Maximum clot firmness was the only evaluated method of fibrinogen assessment to yield consistent results across all categories of fibrinogen deficiency. These in-vitro results suggest the potential clinical utility of rotational thromboelastography as a versatile method for monitoring the response to fibrinogen concentrate among patients with fibrinogen deficiency. Clinical investigations using rotational thromboelastography after in-vivo fibrinogen administration to patients with congenital fibrinogen deficiency are warranted. © 2008 Lippincott Williams & Wilkins, Inc.