Fibrinolysis

D-dimer Reference Range

Paul Smith writes, “I have a family member on Xarelto and his D-dimer reference range was 450 while taking Xarelto. What is the reference range? Hello, Mr. Smith, and thank you for your question. There is some mild confusion about the D-dimer reference intervals (reference ranges) because several distributors use varient methods. These methods result […]

Anticoagulant Therapy

March, 2018 Quick Question: D-dimer Controls

Here are the results of our March, 2018 Quick Question about the appropriate D-dimer controls. What controls are most valid for managing D-dimer assay precision? VTE decision point control only; 500 ng/mL FEUs 10% (3) Low end of linearity & VTE decision point: 100 and 500 ng/mL FEUs: 32% (10) Low and high ends of […]

Inflammatory Biomarkers

Wherever you turn you see reference to the effects of chronic inflammation related to heart disease, stroke, diabetes, and chronic kidney disease. Here is a link to a March, 2018 CAP Today article by Anne Paxton about the relationship of inflammatory biomarkers to chronic kidney disease in diabetes. George is especially interested in the tie-in […]

TXA in DIC

A colleague asks what people are doing in regards to the antifibrinolytic TXA use in patients with DIC who are massively hemorrhaging. George has found a number of articles describing the efficacy of tranexamic acid and epsilon-amino-caproic acid in treating post-partum hemorrhage, which is close, but nothing directly recording TXA in DIC. If you have […]

Dr. John Olson on D-dimer Vs FDP

Hello George, Good to hear from you. I hope that all is well with you. Greet the folks at Precision the next time you see them. There are a number of questions that would be good to raise. For example, for what clinical situations are the OB docs using FSP? It cannot, of course, be used […]

D-dimer versus FDP

From Anne Gaffney: Hi George, we would like to discontinue our fibrin degradation products (FDP, fibrin split products, FSP) latex agglutination testing, however the OB docs like to use the less sensitive test as the D-dimer test is “always” positive in their pregnant patients. Do you have any evidence based literature to help us support […]

August Quick Question: Fibrinolysis

Here are the results of our August, 2017 Quick Question with 68 total votes: How do you test for fibrinolysis? a. TEG or TEM: 9 (13%) b. D-dimer: 36 (53%) c. Plasminogen: 0 (0%) d. PAI-1: 1 (1%) e. D-dimer plus plasminogen: 10 (15%) f. D-dimer, plasminogen, and PAI-1: 6 (9%) f. We don’t test […]

Unable to Obtain Dimer Result on Xarelto

From Heather DeVries, Indiana University Health. Hi George! We use the DDHS kit from IL on our TOP series instruments. There is a cancer patient at one of our facilities who has not been able to get a dimer result while on Xarelto. From the error codes, it looks like it would be human anti-mouse […]

Anticoagulant Therapy

D-dimer AMR and CRR

From Heather DeVries, Indiana University: Greetings George! The labs within our system have been discussing our reportable range for D-dimers. Our vendor’s stated limit is beyond what calculates from our AMR and maximum dilution. We are debating changing our reportable range to what we calculate, and stop using the vendor’s limit so that we truly […]

D-dimer Interference

With reference to our September 8, 2016 discussion entitled Still More on Xarelto and D-dimer, attached is information on another individual with whom I have been corresponding for several months whose D-dimer remains moderately to markedly elevated but whose lab results have demonstrated there is no human anti-mouse antibody or rheumatoid factor present. This person, […]

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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.

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