35. Diagnosis of Fibrinolytic Disorders

  1. Kandice Kottke-Marchant MD, PhD2,3,4 and
  2. Bruce H. Davis MD5
  1. Wayne Chandler MD

Published Online: 8 AUG 2012

DOI: 10.1002/9781444398595.ch35

Laboratory Hematology Practice

Laboratory Hematology Practice

How to Cite

Chandler, W. (2012) Diagnosis of Fibrinolytic Disorders, in Laboratory Hematology Practice (eds K. Kottke-Marchant and B. H. Davis), Wiley-Blackwell, Oxford, UK. doi: 10.1002/9781444398595.ch35

Editor Information

  1. 2

    Pathology & Laboratory Medicine Institute, Cleveland, OH, USA

  2. 3

    Department of Pathology, Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA

  3. 4

    Hemostasis and Thrombosis, Department of Clinical Pathology, Cleveland Clinic, Cleveland, OH, USA

  4. 5

    Trillium Diagnostics, LLC, Bangor, ME, USA

Author Information

  1. Department of Pathology and Laboratory Medicine, The Methodist Hospital, Houston, TX, USA

Publication History

  1. Published Online: 8 AUG 2012
  2. Published Print: 10 APR 2012

ISBN Information

Print ISBN: 9781405162180

Online ISBN: 9781444398595



  • fibrinolysis;
  • tissue plasminogen activator;
  • plasminogen activator inhibitor;
  • antiplasmin;
  • bleeding;
  • thrombosis


The fibrinolytic system regulates the removal of fibrin from the vascular system. Tissue plasminogen activator (tPA) released from endothelial cells activates plasminogen to plasmin on the surface of the fibrin clot. Plasmin degrades or lyses fibrin releasing D-dimer and other degradation fragments. tPA is inhibited by plasminogen activator inhibitor type 1 (PAI-1), plasmin is inhibited by α2-antiplasmin. Deficiencies of PAI-1 or α2-antiplasmin are associated with an increased risk of bleeding due to the removal of hemostatic clots by uncontrolled fibrinolysis. Acquired fibrinolytic bleeding can also occur due to tPA release during cardiopulmonary bypass or decreased clearance during liver transplantation. D-dimer levels may be useful in the evaluation of suspected deep vein thrombosis and pulmonary embolism in an outpatient or emergency room setting. While elevated levels of PAI-1 are associated with reduced fibrinolytic activity, PAI-1 is not an independent predictor of cardiovascular disease.