Fibrinolysis

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 […]

May 2020 Quick Question: D-dimer Results

Our May, 2020 Quick Question, which attracted 70 responses, was, “What assay does your lab use to monitor DIC?” The answers were somewhat predictable, only with a twist. They were: a. FDP: 1% [1] b. D-dimer: 69% [48] c. FDP & D-dimer: 30% [21] d. Other, please comment: 0 These findings are interesting because most […]

May 2020 Quick Question: D-dimer

Colleague Dave McGlasson commented that some of the Covid articles from China reported D-dimer and fibrin degradation products (FDPs) on their critically ill patients, prompting our May, 2020 Quick Question, What assay do you use to monitor disseminated intravascular coagulation (DIC)? If you answer “neither,” please indicate in the comments section if you use one […]

More on D-dimer Reporting

Continuing in our D-dimer discussion, click or tap to read “Raising D-dimer Threshold Cuts Need for Chest Imaging by 30% in Suspected Pulmonary Embolism.” This article appears in the January/February issue of Clinical Laboratory News and refers to Kearon C, de Wit K, Parpia S, et al. Diagnosis of Pulmonary Embolism with d-Dimer Adjusted to […]

D-dimer Reporting Issues

Click or tap here for a January, 2020 Karen Titus CAP Today feature article on concerns around D-dimer assay reporting. The article focuses on unit variation, including FEUs versus DDUs, appropriate usage in ruling out DVT and PE, and emergency department turn-around times. Contributors include Kristin Lundy, MLS, Vermont; Drs. Andrew Goodwin, Vermont; Karen Moser, […]

High-sensitivity D-dimer?

A colleague has seen references to a “High-sensitivity” D-dimer assay. George answered he’s not heard of this, perhaps it is just a synonym for a standard D-dimer assay. If you have any experience with this, please respond to [email protected] or comment below.

Effect of High HCT on D-dimer Results

From Heather DeVries, Indiana University Medical Center. I’m seeking some advice on how to handle D-dimers in patients with elevated hematocrits. I saw a post on this subject in Fritsma Factor back in 2013. CLSI H59-A says to follow H21-A5 in general, which of course says to correct the anticoagulant volume. IL’s package insert for […]

More on D-dimer Elevated 6 Months

Here is a follow-up on yesterday’s (July 23, 2019) case study describing chronically elevated D-dimer. Our correspondent has graciously offered her permission to post her message (anonymously, of course). Another question for you. If there were a blood clot in my lungs would the CT chest scan be a definitive factor for ruling it out? […]

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George Fritsma is a medical laboratory scientist, educator, and author. George is a member of the International Society on Thrombosis and Hemostasis, the International Society for Laboratory Hematology, and the American Society for Clinical Laboratory Science.

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