Laboratory diagnosis of abnormal fibrinolysis

Test	Primary hyperfibrinolysis	DIC	TTP
CBC and blood smear	Normal	Thrombocytopenia, MAHA	Thrombocytopenia, MAHA
PT and aPTT	Normal or prolonged	Prolonged	Normal
Fibrinogen	Decreased	Decreased	Normal
D-dimer or FDP*	Increased	Increased	Normal
Antithrombin	Normal	Decreased	Normal
Euglobulin clot lysis time	Shortened	Shortened	Normal
ADAMTS13 activity	Normal	Normal or mildly reduced^¶	Severely deficient (usually <10%)^Δ

Refer to UpToDate topics on disorders of fibrinolysis, DIC, and TTP for additional details.

DIC: disseminated intravascular coagulation; TTP: thrombotic thrombocytopenic purpura; CBC: complete blood count; MAHA: microangiopathic hemolytic anemia, characterized by anemia, laboratory markers of hemolysis, and schistocytes on the blood smear; PT: prothrombin time; aPTT: activated partial thromboplastin time; FDP: fibrinogen degradation products; ADAMTS13: von Willebrand factor-cleaving protease (a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13).
* FDP is not routinely measured.
¶ ADAMTS13 activity may be mildly reduced (activity, 20 to 60%) in the setting of acute illness.
Δ Refer to UpToDate for a discussion of the role of ADAMTS13 activity testing in the diagnosis of TTP.

Modified with permission from: Rocha E, Paramo JA, Montes R, Panizo C. Acute generalized, widespread bleeding. Diagnosis and management. Haematologica 1998; 83:1024. Copyright © 1998 Ferrata Storti Foundation.

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Laboratory diagnosis of abnormal fibrinolysis