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Soluble Fibrin Monomer Complex (SFMC)

The presence of detectable soluble fibrin monomer complexes (SFMC) in the plasma indicates that coagulation has been activated and circulating thrombin has been generated, as in disseminated intravascular coagulation (DIC). This test has been used in the past as one of the confirmatory tests for DIC, but has been of limited clinical value due to its relatively low sensitivity. SFMC has been largely replaced by D-Dimer. 

The D-dimer assay is one of the most useful confirmatory tests for DIC, reflecting the presence of cross-linked fibrin degradation products in the plasma, and indicating activation of both the coagulation pathway (with generation of thrombin) and the fibrinolytic pathway (with generation of plasmin). It is noteworthy that the D-dimer assay is useful not only for confirming a diagnosis of DIC, but can also be used to differentiate secondary fibrinolysis, usually associated with DIC, from primary activation of the fibrinolytic pathway (primary fibrinolysis), which is relatively rare, and may be associated with various neoplasms. The FDP assay, which detects fibrinolytic breakdown products of fibrinogen and cross-linked fibrin, will be positive in both primary and secondary fibrinolysis. The D-dimer assay, specific for cross-linked fibrin degradation products, is positive only in secondary fibrinolysis.

 

Test

Primary Fibrinolysis

Secondary Fibrinolysis

FDP

+

+

D-dimer

-

+

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