Fibrin Split Products

Definition

Fibrin split products (FSP) are fragments of protein released from a dissolving clot. The fibrin split products test is one of several tests done to evaluate a person with blood clotting problems (coagulation), particularly disseminated intravascular coagulation (DIC).

Purpose

High levels of FSP in a person's blood are associated with DIC, a serious medical condition that develops when the normal balance between bleeding and clotting is disturbed. Excessive bleeding and clotting injures body organs, and causes anemia or death.

Description

Coagulation begins typically with an injury to some part of the body. The injury sets in motion a cascade of biochemical activities (the coagulation cascade) to stop the bleeding, by forming a clot from a mixture of the blood protein fibrin and platelets.

Once bleeding is stopped, another blood protein dissolves the clot by breaking down the fibrin into fragments. Measurement of these fragments gives information about the clot dissolving portion of coagulation, called fibrinolysis.

In DIC, the coagulation cascade is triggered in an abnormal way. A blood infection, a transfusion reaction, a large amount of tissue damage, such as a burn, a dead fetus, and some cancers can begin the chain of biochemical events leading to blood clots. The coagulation cascade becomes overwhelmed with excessive clotting followed by excessive bleeding. As the large number of clots dissolve, fibrin split products accumulate in the blood and encourage even more bleeding.

Laboratory tests for FSP are done on the yellow liquid portion left over after blood clots (serum). A person's serum is mixed with a substance that binds to FSP. This bound complex is measured, and the original amount of FSP is determined. Some test methods give an actual measurement of FSP; some give a titer, or dilution. Methods that provide a titer look for the presence or absence of FSP. If the serum is positive for FSP, the serum is diluted, or titered, and the test is done again. These steps are repeated until the serum is so dilute that it no longer gives a positive result. The last dilution that gives a positive result is the titer reported.

The FSP test is covered by insurance when medically necessary. Results are usually available within one to two hours. Other names for this test are fibrin degradation products, fibrin breakdown products, or FDP.

Preparation

This test requires 0.17 oz (5/14m) of blood. A healthcare worker ties a tourniquet on the patient's upper arm, locates a vein in the inner elbow region, and inserts a needle into that vein. Vacuum action draws the blood through the needle into an attached tube. Collection of the sample takes only a few minutes.

Aftercare

Discomfort or bruising may occur at the puncture site. Pressure applied to the puncture site until the bleeding stops reduces bruising. Warm packs to the puncture site relieve discomfort. The patient may feel dizzy or faint.

Risks

People with coagulation problems may bleed longer than normal. The healthcare provider must make sure bleeding has stopped before leaving the patient unattended.

Normal results

Negative at a less than or equal to 1:4 dilution or less than 10 g/mL.

Abnormal results

High levels of FSP indicate DIC. Results of the test must be interpreted by the physician according to the person's clinical symptoms and medical history. Other conditions that increase blood clotting activity also increase FSP: venous thrombosis, surgery and transplants, blood clots in the lung, certain cancers, and heart attack (myocardial infarction).

Resources

BOOKS

Miller, Jonathan L. "Blood Coagulation and Fibrinolysis." In Clinical Diagnosis and Management by Laboratory Methods, edited by John B. Henry., 19th ed. Philadelphia: W. B. Saunders Co., 1996.

PERIODICALS

Hardaway, Robert M., and Charles H. Williams. "Disseminated Intravascular Coagulation: An Update." Comprehensive Therapy November 1996: 737-743.

KEY TERMS

Coagulation— The entire process of blood clotting.

Coagulation cascade— A sequence of biochemical activities to stop bleeding by forming a clot.

Disseminated intravascular coagulation (DIC)— A serious medical condition that develops when the normal balance between bleeding and clotting is disturbed. Excessive bleeding and clotting injures body organs, and causes anemia or death.

Fibrin split products (FSP)— Pieces of the protein fibrin released from a dissolving clot.

Fibrinolysis— The clot dissolving portion of the coagulation process.

Titer— A dilution of a substance with an exact known amount of fluid. For example, one part of serum diluted with four parts of saline is a titer of 1:4.