Fibrinolysis

Isolated Chronically Elevated D-dimer

I [Geo] have had a number of questions from people who report a chronically elevated D-dimer with no clinical associations or parallel positive laboratory assays. In many cases their original D-dimer was ordered in response to a clinical indication such as chest pain or possible C19 symptoms, and remained elevated long after the original event […]

Coagulation Overview

In response to requests, we’ve posted our latest audio PowerPoint module, “Coagulation Overview.” Please visit our growing list of recently produced free modules under the menu heading, Educational Modules.

Coagulation Factors

D-dimer and DOACs

Here is a recent question from a colleague. “Dear George, A patient with a PE of unknown etiology, is now completing their 6th month of Eliquis therapy. When is the ideal time to check a D-dimer? Thank you.” Before answering, I [Geo] consulted with Dr. Larry Brace, who responds, “My opinion is that if the […]

Anticoagulant Therapy

Covid-Coag Controversies 10-18-20 Video

Click here to watch George Fritsma’s 50-minute presentation, COVID-Coag; Controversies and Confusion. This is a follow-up to our September 15 presentation featuring Dr. Andrew Goodwin, and was provided as part of the Imtermountain States Seminar annual meeting in virtual format. Special thanks to Holly Weinberg for her invitation and for coordinating the event.

Sept, 2020 Quick Question Reponse: Fibrinolysis

Here are our responses to the September, 2020 Quick Question, wich attracted 51 participants. How does your facility measure fibrinolysis? Plasminogen: 3 [5%] Tissue plasminogen activator [TPA]: 1 [2%] Plasminogen activator inhibitor 1 [PAI-1]: 1 [2%] Thromboelastograph [TEG]: 10 [20%] Rotational thromboelastometry [ROTEM]: 36 [71%] As we speculated the first three measures of fibrinolysis are […]

D-dimer Reporting

Hemostasis laboratory directors are aware of the problems created by the variety of D-dimer result expressions. D-dimer reagent kit manufacturers have failed to harmonize results, in part because their reagent monoclonal antibodies possess variant specificities, and in part because some report results in “D-dimer units” [DDUs] and some in “fibrinogen equivalent units” [FEUs]. FEU values […]

Sept, 2020 Quick Question: Fibrinolysis

Introducing our September, 2020 Quick Question, a laboratory service poll, “How do you measure fibrinolysis?” Please select your answer on the right or if you don’t see the answer you are looking for, please add your comment below.

August, 2020 Quick Question on D-dimer Results

Our August, 2020 Quick Question asks, “What condition may account for a chronically elevated D-dimer?” We’ve had 59 respondents with a broad distribution of results: Plasma human anti-mouse antibody: 7% [4] Rheumatoid factor: 14% [8] Chronic low-grade inflammation: 24% [14] Venous thromboembolic disease: 17% [10] Disseminated intravascular coagulation: 34% [20] Other, please comment: 4% [3] […]

Markedly Elevated D-dimer in an Infant

A 4 month old girl was being prepped for surgery for a neural tube defect. All lab results were normal except her D-dimer result, which was greater than 20,000 ng/mL FEUs. The girl was in apparent good health, but the surgeon postponed surgery. The test was repeated after three days and the new D-dimer result […]

July, 2020 Quick Question on Covid Coag Results

Our July, 2020 Quick Question, “What assay does your lab use to monitor Covid-19 severity?” attracted 64 responses that were nearly unanimous. Answers: Fibrin degradation products: 3 [5%] D-dimer: 53 [83%] PT and PTT: 3 [5%] Platelet count: 1 [2%] Other: 4 [6%] Several publications, especially from China, record the parallel use of FDPs and […]

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George Fritsma is a medical laboratory scientist, educator, and author. George holds faculty appointments with Rutgers University and Michigan State University, and is a member of the International Society on Thrombosis and Hemostasis, American Association of Clinical Chemists, and American Society for Clinical Laboratory Science.

Cheat Sheets from George

Quick Question