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This article is part of the supplement: 32nd International Symposium on Intensive Care and Emergency Medicine

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Fractal dimension: a biomarker for detecting acute thromboembolic disease

K Hawkins1*, N Badiei1, J Weisel2, I Chernysh2, PR Williams1, MJ Lawrence1 and PA Evans1

  • * Corresponding author: K Hawkins

Author Affiliations

1 Swansea University, Swansea, UK

2 University of Pennsylvania, Philadelphia, PA, USA

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Critical Care 2012, 16(Suppl 1):P431  doi:10.1186/cc11038

The electronic version of this article is the complete one and can be found online at:

Published:20 March 2012

© 2012 Hawkins et al.; licensee BioMed Central Ltd.

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


This study investigates the potential use of rheometry to provide a structural biomarker for acute critical illness. Previous studies have reported an association of altered fibrin clot network architecture with several diseases including sepsis, bleeding or acute thromboembolic disease [1]. We investigate our biomarker by examining the relationship between thrombin generation and clot architecture in an in vitro model.


Rheometry and confocal laser scanning microscopy (CLSM) were used to monitor and image the formation of fibrin clots. Clotting was initiated by the addition of different levels of thrombin to solutions of a fixed concentration of fibrinogen. Each sample was divided into two aliquots; one added to the measuring geometry of an AR-G2 rheometer and one to the microscope slide for the spinning disk CLSM (Olympus IX71).


The micrographs of formed clots (Figure 1) show marked qualitative differences in clot architecture. Upon increasing the available thrombin, the clot network (visually) appears more dense. Table 1 shows the value of the structural biomarker, the fractal dimen-sion, that corresponds to the clots formed in Figure 1.

thumbnailFigure 1. CLSM micrographs of formed fi brin clots at thrombin levels of 0.02, 0.1 and 0.3 NIH.

Table 1. Results of the fractal dimension obtained by rheometry of fibrin clots


We demonstrate, for the first time, that the fractal dimen-sion obtained by rheometry is a sensitive measure of visually observed structural differences within the fibrin network. Rheometrical detection of incipient clots formed in whole blood provides the clinician with a powerful tool for the diagnosis of thromboembolic disease.


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    Arterioscler Thromb Vasc Biol. 2004, 2:1558-1566. OpenURL