Q: What is the caveat of measuring fibrinogen level in patients with liver disease? 


Answer:  Liver disease is mostly marked by (acquired) dysfibrinogenemia, not low fibrinogen level. This results in normal fibrinogen levels when measured by immunologic methods. Dysfibrinogenemia can be establish by demonstrating prolong thrombin and reptilase times.

Clinically, this is important as clinicians may get deceived by normal fibrinogen level but patient may continue to bleed due to dysfibrinogenemia.


References:

1.  Francis JL, Armstrong DJ. Acquired dysfibrinogenaemia in liver disease. J Clin Pathol 1982; 35:667. 

2. Regañón E, Vila V, Aznar J, et al. Study of the formation of fibrin clot in cirrhotic patients. An approach to study of acquired dysfibrinogenemia. Thromb Res 1987; 46:705. 

3. Mammen EF. Coagulopathies of liver disease. Clin Lab Med 1994; 14:769.