normal Fibrinogen in sepsis

 Q: 77 years old female is admitted to ICU with severe urosepsis shock. Disseminated intravascular coagulation (DIC) panel was sent by an on-call resident.  Normal fibrinogen level in severe suspected sepsis is a good sign?

A) True

B) False

Answer: B

Hypofibrinogenemia is a cardinal feature of acute DIC. On the same token fibrinogen is also an acute phase reactant. So there are two paradox processes occurring in severe sepsis.

Production vs Consumption

In milder sepsis production of fibrinogen is usually lower than consumption. In patients with underlying severe sepsis (or cancer and inflammatory conditions), the production of fibrinogen is significantly higher. Normal plasma fibrinogen level is due to higher production than consumption in these patients and may deceive the bedside clinician.

#hematology

Reference:

Gruys E, Toussaint MJ, Niewold TA, Koopmans SJ. Acute phase reaction and acute phase proteins. J Zhejiang Univ Sci B. 2005;6(11):1045-1056. doi:10.1631/jzus.2005.B1045