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In vivo effect of hydroxyethyl starch solution (HES 130/0.4) on different fibrinogen assays

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Previous in vitro studies have shown that photometric assays may overestimate fibrinogen levels after hemodilution with HES. The in vivo effect of HES on fibrinogen assays was therefore studied.


Forty patients with intracranial tumor gave their consent to participate in this ethical approved study. Plasma fibrinogen levels were analyzed with ELISA, two photometric assays (Dade and Multifibren) and one mechanical (Hook). In addition, ROTEM FibTEM- MCF was analyzed.


Twenty-five of the 40 patients received 1 l HES. Mean reduction of hematocrit was 17%. ELISA was lower than Hook and Multifibren. The FibTEM relative decrease of 43% differed significantly from the other assays. See Figure 1.

Figure 1

Relative change of P-fibrinogen compared with preoperative values.


After in vivo hemodilution with HES, some assays overestimated fibrinogen levels. An overestimation of around 0.3 g/l may lead to undercorrection of fibrinogen in critical bleeding situations. The aggravated response on the FibTEM-MCF may better reflect HES effects on clot structure.

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Correspondence to U Schött.

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Schött, U., Winstedt, D. & Hillarp, A. In vivo effect of hydroxyethyl starch solution (HES 130/0.4) on different fibrinogen assays. Crit Care 18, P155 (2014).

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  • Public Health
  • Starch
  • Emergency Medicine
  • Fibrinogen
  • Hydroxyethyl