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6 protocols using multifibren u reagent

1

Fibrinogen Measurement Protocol for ISSHL

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Blood was drawn by venipuncture at the time when hearing recovery was determined, which was at least 8 weeks after ISSHL to avoid acute phase reactions secondary to the acute event. Fibrinogen was measured in citrated plasma after centrifugation for 15 min at 2,500 g. The sample analysis was done within 1 h after venipuncture. DNA was extracted from EDTA-treated blood by a spin column procedure (Quiagen, Germany).
Fibrinogen was determined using the Multifibren U reagent (BCS analyzer; Dade Behring). The coagulation process was initiated by adding a large excess of thrombin to the plasma sample. The time until formation of a fibrin clot was measured. The fibrinogen concentration was then calculated from a standard curve prepared by measuring fibrinogen calibrators of a known concentration. All other routine measurements were performed as previously described [19] (link).
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2

Fibrinogen Dynamics during Cardiac Surgery

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Data were stored on a departmental research platform (Labkey, Seattle, WA, USA). Fibrinogen was measured using the Clauss method (Clauss fibrinogen, C-FIB) and using fibrin-based thrombo-elastometry (FIBTEM-MCF assay, ROTEM®, TEM International GmbH, Munich, Germany). Whole blood was serially sampled in citrated plastic containers (Monovette, Sarstedt AG, Nümbrecht, Germany) at defined time points as follows: baseline level (pre-CPB value) before anesthesia induction; AodX, five minutes after aortic declamping; Protamine, five minutes after protamine administration; and T1, T2, T3, T4, T6, T8, T12, T18, and T24 at 1, 2, 3, 4, 6, 8, 12, 18, and 24 hours after protamine administration, respectively. All samples were immediately sent to the laboratory, pre-heated to 37°C, and analyzed within 15 minutes. C-FIB was determined using the Multifibren U reagent (Dade Behring, Liederbach, Germany) on a BCS-XP coagulometer (Siemens Healthcare, Marburg, Germany). For FIBTEM, tissue factor was used as the activator, and cytochalasin D was added for platelet inhibition. To minimize user-dependent variability, all coagulation and viscoelastic testing was performed by the hemostasis laboratory.
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3

Automated Hematology and Coagulation Assays

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The number of platelets was determined on the Sysmex XE-2100TM Automated Hematology System (Sysmex Austria GmbH, Vienna, Austria). The PT (Thromborel® S reagent, Siemens Healthcare Diagnostics GmbH, Vienna, Austria), APTT (Pathromtin® SL reagent, Siemens Healthcare Diagnostics GmbH, Vienna, Austria), and fibrinogen (Multifibren® U reagent, Siemens Healthcare Diagnostics GmbH, Vienna, Austria) were measured on the Siemens/Dade Behring BCS XP Analyzer Automated Coagulation System (Siemens Healthcare Diagnostics GmbH, Vienna, Austria). Daily QC measurements were performed with commercially available control material within the normal and pathological ranges (Control Plasma N and P (Siemens Healthcare Diagnostics GmbH, Vienna, Austria): PT 73.0 - 109.0% and 32 - 48%; APTT 28.0 - 38.0 s and 70 - 105 s; fibrinogen 2.2 - 3.2 g/L and 0.6 - 1.4 g/L, respectively; e-CHECK®(XE) (Sysmex Austria GmbH): platelet counts 195 – 240 G/L, 30 – 75 G/L and 480 - 580 G/L). Inter-assay precision was calculated with results of minimum 20 consecutive days. One tenfold measurement was performed at one day to determine the intra-assay precision. The intra- and inter-assay CV were as follows: for PT 1.71 and 3.26%, respectively; for PT-INR 2.43 and 3.24%, respectively; for APTT 2.31 and 2.83%, respectively; for fibrinogen 1.23 and 2.87%, respectively; and for platelet count 1.23 and 3.4%, respectively.
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4

Comprehensive Coagulation Profile Analysis

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Fibrinogen (Multifibren® U reagent, Siemens Healthcare Diagnostics GmbH, Vienna, Austria), Factor VIII (Pathromtin® SL reagent and factor VIII deficient plasma, Siemens Healthcare Diagnostics GmbH, Vienna, Austria), Factor XIII (Berichrom FXIII reagent Siemens Healthcare Diagnostics GmbH, Vienna, Austria) as well as vWF Activity and ADAMTS13 (Innovance vWF Ac assay, Siemens Healthcare Diagnostics GmbH, Vienna, Austria) were measured on the Atellica COAG 360 Coagulation System (Siemens Healthcare Diagnostics GmbH, Vienna, Austria). Thrombin Generation was measured on the BCS XP Coagulation Analyzer using Endogenous Thrombin Reagent (Innovance ETP, (Siemens Healthcare Diagnostics GmbH, Vienna, Austria). Functional fibrinogen test was performed on the TEG 5000 analyzer (Haemonetics, Vienna, Austria) at the various time points, respectively.
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5

Comprehensive Coagulation Pathway Analysis

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The activated partial thromboplastin time was measured using Dade Actin FSL–activated PTT reagent (Siemens Healthcare Diagnostics, Marburg, Germany), prothrombin time (PT) was measured using Dade Innovin reagent (Siemens Healthcare Diagnostics), fibrinogen levels were determined with Multifibren U reagent (Siemens Healthcare Diagnostics), and D-dimer was measured using INNOVANCE D-Dimer kits (Siemens Healthcare Diagnostics). All assays were performed according to the manufacturer instruction using a BCS system (Siemens Healthineers, Erlangen, Germany). Prothrombin fragment 1+2 was measured using Enzygnost F1+2 ELISA kits (Siemens Healthineers) following the manufacturer instructions. Activated coagulation factors in complex with their natural inhibitors (ie, activated FVII:antithrombin [FVIIa:AT], FXIIa:AT, FXIIa:C1 esterase inhibitor [FXIIa:C1Inh], FXIa:AT, FXIa:alpha1-antitrypsin [α1AT], FXIa:C1Inh, FIXa:AT, FXa:AT, and thrombin:antithrombin [T:AT]) were quantified as described.10 (link), 11 (link), 12 (link) In short, FVIIa:AT represents activation of the extrinsic pathway, FXIIa:AT, FXIIa:C1Inh, FXIa:AT, FXIa:α1AT, FXIa:C1Inh, and FIXa:AT represent activation of the intrinsic pathway, and FXa:AT as well as T:AT represent activation of the common pathway of coagulation.
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6

Comprehensive Coagulation Profile Analysis

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Platelet counts were determined using a Coulter Counter LH750 (Beckman-Coulter Inc., Nyon, Switzerland).
Plasma levels of fibrinogen were measured according to the Clauss method using Multifibren U reagent (Siemens Healthcare Diagnostics, Marburg, Germany). [20 (link)] Prothrombin time was determined using Dade Innovin (Siemens Healthcare Diagnostics, Marburg, Germany) and aPTT was measured using Pathrombin SL (Siemens Healthcare Diagnostics, Marburg, Germany). All analyses were run on a CS5100 coagulometer (Siemens Healthcare Diagnostics, Marburg, Germany). Thromboelastometry analysis was performed on a ROTEM delta analyzer according to the manufacturer’s instructions (ROTEM delta; Tem International GmbH, Munich, Germany) with multiple-test reagents. INTEM, EXTEM, FIBTEM, and HEPTEM test were conducted in citrated whole blood following a including the 5-minute pre-heating procedure.
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