الفهرس 
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Abstract
Cirrhosis is a pattern of liver injury that is characterized by necroinflammation and fibrogenesis ; histologically it is characterized by diffuse nodular regeneration surrounded by dense fibrotic septa with subsequent parenchymal extinction and collapse of liver structures, together causing pronounced distortion of hepatic vascular architecture with subsequent portal hypertension and hepatic synthetic dysfunction. Fibrin monomer is one of fibrin related markers (FRMs) . Fibrin fibers are formed from soluble fibrinogen after removal of fibrinopeptides A and B by the serine protease thrombin. Fibrin monomers are likely to contribute to pathologies associated with thrombotic complications of chronic liver disease, such as portal vein thrombosis. This study aimed to study fibrin monomer in chronic HCV patients with and without portal hypertension aiming to investigate it`s value in these patients and if it aides in early detection of thrombus formation . This study included 25 HCV cirrhotic patients without portal hypertension , 25 HCV cirrhotic patients with portal hypertension .and 25 apparently healthy volunteers who serves as control group and conducted at Clinical Pathology Department in Tanta University. All patients will be subjected to the following: • Complete history taking. • General clinical examination. • Abdominal ultra sonography. • Laboratory investigation including. Routine investigations: 1. Complete blood picture (CBC). 2.Liver function tests (total bilirubin – direct bilirubin – serum total protein – serum albumin – ALT-AST –Alkaline phosphatase – blood ammonia level - Gamma glutamyl transferase) 3. Prothrombin time( PT) and International normalized ratio( INR) . 4. Fibrongen level 5. Activated partial thrombiplastin time. (APTT) 6- D.Dimer 7-Hepatitis markers : -HBs Ag -HCV Ab 8- Alfa feto protein 9-HCV PCR RNA Specific investigations: Measurement of plasma fibrin monomer. This study revealed: In this study , there was increase in serum total bilirubin , creatinine ,INR , APTT ,AFP ,WBCs, D-Dimer ,viral load in HCV cirrhotic patients with and without portal hypertension compared to control group, while there were decrease in serum albumin , and platelets count ,and fibrinogen level in HCV cirrhotic patients with and without portal hypertension compared to control group . Also, there was increase in portal vein caliber and spleen size in HCV cirrhotic patients with and without portal hypertension compared to control group. In the present study , the plasma level of fibrin monomer was significantly higher in cirrhotic patients without portal hypertension than control group and fibrin monomer level was significantly higher in cirrhotic patients with portal hypertension than cirrhotic patients without portal hypertension. There was positive correlation between fibrin monomer andeach of (portal vein caliber , spleen size , D.dimer level ,viral load ,INR, T.BIL, and AFP) , and negative significant correlation between fibrin monomer and each of ( Platelet count , albumin and fibrinogen). In cirrhotic group with and without portal hypertension as compared to control group • Portal vein caliber cutoff was 11 cm , sensitivity 84 % , specificity 92 % ,positive predictive value 95%, negative predictive value 74% and accuracy 87%. • Fibrinogen cutoff was 250 mg/dl, sensitivity 76 % , specificity 60 % , positive predictive value79%, negative predictive value 56% and accuracy 70%. • D-Dimer cutoff was 3000 μg/dl, sensitivity 84 % , specificity 75 % , positive predictive value 86%, negative predictive value 71% and accuracy 79%. • Fibrin monomer cutoff was 13μg/ml sensitivity 100 % , specificity 100 % , positive predictive value 100 %, negative predictive value 100% and accuracy 100%. ion 100 Utilizing ROC curve ,it was found that soluble fibrin monomer complex has a great sensitivity and specifity in early predicting thrombus generation in chronic cirrhotic patients as its level are greater in cirrhotic patients without portal hypertension ( group 2) than control group ( group 1) . Also, it has higher values in cirrhotic patients with portal hypertension (group 3) than cirrhotic patients without portal hypertension ( group2).