In a bleeding patient, selecting the most appropriate therapy should be made evidence based, especially when blood products are being considered.

In particular platelet concentrates have significant risks and side effects (B. Spiess: Blood Transfusion: The Silent Epidemic, Ann Thorac Surg 2001;72:S1832-7). They should be given only to those patients who have a platelet problem but not to the patient with impaired clotting due to defective fibrin formation.

A differentiation between platelet function and the fibrin polymerisation process is possible with the fib-TEM^® reagent. This reagent eliminates platelet function with a powerful platelet inhibitor (cytochalasin D). While clots obtained in EXTEM or INTEM are composed of platelets and fibrin, the clot obtained in the FIBTEM assay is primarily a fibrin clot.

With FIBTEM, the sensitive detection of fibrin polymerisation disorders (e.g. induced by fibrinogen deficiency, fibrinogen split products, in DIC or liver disease, inhibiting antibodies, drugs or colloids) is possible.

This information is helpful for the decision if platelet concentrates or a substitution of fibrinogen or other plasma products (or both) are necessary. A normal FIBTEM assay rules out that fibrinogen, cryo precipitate or fresh frozen plasma are required.

The difference between clot firmness obtained with EXTEM and FIBTEM represents the platelet contribution in the EXTEM assay. The remaining clot firmness in FIBTEM is a true measure of the fibrinogen status and of F XIII contribution.