PLASMA

FIBRINOG
EN
DONEVA LYN B.
MEDINA
 INTRODUCTION
Fibrinogen (Fib), a blood coagulating protein with its highest content in
plasma, is one of the acute phase proteins, synthesized by liver cells and
megakaryocytes. Fib is closely associated with consumption coagulopathy, liver
diseases, nephropathy syndrome, cardiovascular diseases, diabetes and malignant
tumors, etc. High-levels of Fib is one of the dangerous factors contributing to
coronary heart diseases . Previous reports often focused on hemorrhagic diseases,
thromboembolic diseases and recurrent spontaneous abortions caused by genetic
variation of Fib . More attention needs to be paid to Fib determination in the
clinical field.
A fibrinogen activity test is also known as a Factor I Activity. ‌This test looks at
how well your fibrinogen functions by looking at how long it takes for a blood
clot to form. If it takes too long, it could mean that your fibrinogen is not working
well or that its levels are lower than they should be.
 PURPOSE
The fibrinogen test is used to investigate certain bleeding or clotting
abnormalities, as follows:

• Bleeding disorder
• Thrombotic events
• Suspected DIC
• Abnormalities in coagulation panel (PT/PTT)
• Follow-up in chronic conditions such as liver disease
• Dysfibrinogenemia, in which a fibrinogen antigen test is performed to
differentiate lack of protein in the system or just dysfunctional fibrinogen
• Occasionally used for screening risk of coronary artery disease
INTERPRETATI
ONS
 NORMAL
RESULTS
Adult: 200-400 mg/dL or 2-4 g/L (SI units)
Newborn: 125-300 mg/dL

Normal value ranges may vary slightly among different

laboratories. Some labs use different measurements or may
test different specimens. Talk to your doctor about the
meaning of your specific test results.
 ABNORMAL
RESULTS
Abnormal results may be due to:

● The body using up too much fibrinogen, such as in

disseminated intravascular coagulation (DIC)
● Fibrinogen deficiency (from birth, or acquired after birth)
● Breakdown of fibrin (fibrinolysis)
● Too much bleeding (hemorrhage)

The test may also be performed during pregnancy if the

placenta separates from its attachment to the uterus wall
(placenta abruption).
 ABNORMAL
RESULTS
Elevated fibrinogen
• Genetic factors e.g. G-
455A polymorphism
• Age and female sex
• Season
• Pregnancy and oral
contraception
• Menopause
• Smoking
• Acute exercise
• Acute-phase reactions
Reduced fibrinogen
• Afibrinogenaemia,
hypofibrinogenaemia,
• dysfibrinogenaemia
• Liver disease
• Disseminated intravascular
coagulation
• Thrombolytic therapy
• Defibrinogenation therapy
(ancrod)
• Haemodilution
 NURSING
RESPONSIBILITIES
BEFORE THE
PROCEDURE
PREPARATIONS
● Explain to the patient that the plasma fibrinogen is used to investigate certain
bleeding or clotting abnormalities
● Notify the laboratory and physician of drugs the patient is taking that may
affect test results; it may be necessary to restrict them.
● Tell the patient that the test requires a blood sample.
● Explain who will perform the venipuncture and when.
● Explain to the patient that he may feel slight discomfort from the tourniquet
and the needle puncture.
● Inform the patient that he need not to restrict food and fluids.
 NURSING
RESPONSIBILITIES
DURING THE
PROCEDURE
PREPARATIONS
● Uses standard precaution/Sterile technique as appropriate
● Provides emotional and physical support
● Monitors patient
● Ensures correct labeling, storage and transportation of specimen
IMPLEMENTATIO
N
● Perform a venipuncture and collect the sample in a 3
to 4.5 ml siliconized tube.
● Completely fill the collection tube and invert it gently
several times to mix the sample and the anticoagulant
thoroughly. If the tube isn’t filled to the correct
volume, an excess of citrate appears in the sample.
● To prevent hemolysis, avoid excessive probing during
venipuncture and rough handling of the sample.
 COMPLICATI
PATIEN
ONS
T CARE
• Bruising around puncture site.
• In a very rare case, the ff complication
can occur during and after the blood test:
o An infection at the puncture site.
Apply pressure to the
o Excessive bleeding where needle
venipuncture site until
was inserted
bleeding has stopped. o An accumulation of blood beneath
the skin, called hematoma
NURSING RESPONSIBILITIES/
HEALTH TEACHINGS AFTER
THE PROCEDURE

● If a hematoma develops at the venipuncture site, apply direct pressure. If

the hematoma is large, monitor pulses distal to the phlebotomy site.
● Assess the site for bleeding
● Record the time of day when the blood test is drawn.
● Ensure that the blood tubes are correctly labelled and delivered to the
laboratory.
● Answer the client questions if there is any.
● Tell the patient that he may resume any medication that was discontinued
before the test is ordered.
RHEUMATOID
FACTOR
DONEVA LYN B.
MEDINA
 INTRODUCTI
ON
Rheumatoid Factors (RF) are autoantibodies that react with individuals own immunoglobulin.
These antibodies are usually directed against the Fc fragment of the human IgG. RF have
been associated with three major immunoglobulin classes: IgM, IgG, and IgA. Of these IgM
and IgG are the most common. The formation of immune complex in the joint space leads to
the activation of complement and destructive inflammation, causing rheumatoid arthritis
(RA).

As indicated by its name, RF has particular application to diagnosis and monitoring of

rheumatoid arthritis. Rheumatoid arthritis (RA) is a chronic inflammatory disease affecting
primarily the joints and periarticular tissues. Rheumatoid factor is detected in 60-80% of
cases of diagnosed rheumatoid arthritis. However, it is also detectable sometimes in the serum
of patients with Systemic Lupus Erythematosus (SLE) and in certain non-rheumatic
conditions. Elevated values may also be observed in normal elderly population.
PURPOSE
Most commonly, rheumatoid factor is
used as a blood test for the diagnosis of
rheumatoid arthritis. Rheumatoid factor
is present in about 80% of adults (but a
much lower proportion of children) with
rheumatoid arthritis. Your body
produces antibodies when it detects
harmful substances.
INTERPRETATI
ONS
 NORMAL
RESULTS
Results are usually reported in one of two ways:

● Value, normal less than 15 IU/mL

● Titer, normal less than 1:80 (1 to 80)

The "normal" range (or negative test result) for rheumatoid

factor is less than 14 IU/ml. Any result with values 14 IU/ml
or above is considered abnormally high, elevated, or
positive.
 ABNORMAL
RESULTS
An abnormal result means the test is positive, which means a
higher level of RF has been detected in your blood. A higher level
of rheumatoid factor in your blood is closely associated with
autoimmune disease, particularly rheumatoid arthritis. But a
number of other diseases and conditions can raise rheumatoid
factor levels, including:

● Cancer
● Chronic infections
● Inflammatory lung diseases, such as sarcoidosis
● Mixed connective tissue disease
● Sjogren's syndrome
● Systemic lupus erythematosus
 NURSING
RESPONSIBILITIES
BEFORE THE
PROCEDURE
PREPARATIONS
● Gather, prepare, and clean the equipment needed to ensure less complications.
● Report any broken and damaged equipment immediately.
● Sterilize area before use
 NURSING
RESPONSIBILITIES
DURING THE
PROCEDURE
PREPARATIONS
● Patient may experience lightheadedness, dizziness, and/or fainting during blood
draw:
o Side rails up
o Assist patients when ambulating
● Assist with testing
● Monitor patients during testing
 IMPLEMENTATIO
N
A number of methods are available for testing of RF. The most commonly
used serological method is based on latex agglutination test. As RF is an IgM
class of antibody directed against the Fc portion of
the IgG molecule, it is detected by it’s ability to agglutinate the latex particles
coated with IgG molecule.
During a rheumatoid factor test, a small sample of blood is drawn from a
vein in your arm. This typically takes just a few minutes. Your blood sample is
sent to a laboratory for testing.
● Use fresh serum collected by centrifuging clotted blood.
● If the test cannot be carried out on the same day, the serum may be stored
between 2 - 8°C for no longer than 72 hours after collection.
● For longer periods the sample must be frozen.
● As in all serological tests, hemolytic or contaminated serum must not be used.
● Do not use plasma.
 QUALITATIVE
TEST
● Bring all reagents and specimens to room temperature.
● Place one drop of the positive control and 40ul of the patient serum
into separate circles on the slide.
● Gently and add one drop of RF latex reagent on each circle of sample
to be tested and control.
● Use separate Applicator sticks/stir sticks to spread reaction mixture
over entire area of the particular
● field.
● Tilt the slide back and forth for 2 minutes in a rotary shaker so that
the mixture rotates slowly.
● Observe for agglutination after 2 minutes under bright artificial
light
 QUANTITATIVE
TEST
● Set up at least five test tubes 1 2, 1-4, 1 8, 1 16, 1:32, etc.
● Dilute sample according to dilution factor on each test tube with
glycine saline solution .
● Place one drop of each of positive and negative controls on to the
slide ring . Place 40 pl of each serum dilution on successive fields of
the reaction slides.
● Gently re-suspend the RF latex Reagent and add one drop to each
test field .
● Mix well with the provided stirring sticks Gently rock the slide for
two minutes and read immediately under indirect light .

PATIEN
T CARE
Keep puncture site clean and dry as
there are risks of pain, bleeding,
bruising and infections.
COMPLICATI
ONS
There is very little chance of having a
problem from this test. When a blood sample
is taken, a small bruise may form at the site.
NURSING RESPONSIBILITIES/
HEALTH TEACHINGS AFTER
THE PROCEDURE

● Keep puncture site clean and dry as there are risks of pain, bleeding,
bruising and infections.
● RF testing does not require any restrictions in terms of food, water, or
medications prior to the actual testing.
● Wearing a short-sleeved shirt or an article of clothing that exposes the arm
is ideal.
● Mention phobia of needles/blood, or a condition that affects blood-clotting
ability prior to blood draw.