Fibrinolysis

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, […]

Still More on Xarelto and D-dimer

Here is further follow-up on our April 13 discussion entitled Xarelto and D-dimer (click or tap). In summary, a patient who was on Xarelto had markedly elevated D-dimer results reported by the laboratory where the patient was being treated, but normal D-dimer results when tested at two other laboratories using alternate technologies. George has since […]

More on Xarelto and D-dimer

Dr. Jeanine Walenga, Clinical Coagulation Laboratory Director at Loyola University Medical Center added a helpful comment to our April 13, 2016 discussion about Xarelto and D-dimer. Click here to see the discussion and her comment.

Anticoagulant Therapy

D-dimer Questionnaire

Remember that D-dimer questionnaire link that we asked you to post on Fritsma Factor in early November of 2014?: https://docs.google.com/forms/d/1IVMqgIsZRN_rqbv2PdhPoerRB6UERXdEuCi0Czr-7m0/viewform?usp=send_form. Well, we had a look at the responses and greater than 90% have come from Europe/Australia. Seems that North Americans don’t do D-dimers! We are keeping the link open indefinitely. It would be good to […]

More on Unexplained Elevated D-dimer

Here is an update to Tony Tang’s D-dimer post from Fritsma Factor technical advisor Donna Castellone, QA Manager, Specialty Testing and Supervisor, Special Coagulation and Hematology at New York Presbyterian-Columbia. Donna writes, my input on TEG is limited, however I agree with what you said. Tony can also look at factor V and protein C to […]

Unexplained Elevated D-dimer

From Tony Tang: Dear George, recently we met a 1 year old child with serious hepatitis, the results of coagulation tests were as follows: PT: 26s, APTT: 56s, FIB: 1.07 g/L, TT: 23s, D-dimer: greater than 80 ug/mL FEU, FDP: greater than 360 ug/mL, AT-III: 54%, factor VIII: 212%, PLT count: 102 X 109/L (and […]

More on Age-Adjusted D-dimer Limits

I’d like to draw your attention to the numerous and insightful responses to Sylvia Stacy‘s question about applying age-adjusted D-dimer limits to venous thromboembolic disease diagnosis, especially Dr. Giuseppe Lippi’s entry with a link to his brief questionnaire, which he intends to keep open through February, 2015. Let’s give Dr. Lippi as many responses as possible.

Age-adjusted D-dimer Limit?

Hi George, I am wondering if anyone is using the age-related D-dimer cutoff for the emergency room based on the ADJUST-PE study? We use Innovance D-dimer reagents from Siemens on the BCS XP analyzer. Our ER physicians are very impatient for us to allow them to use this age-adjusted cut-off, but we have reservations due […]

Wide D-dimer Fluctuations

From Tony Tang, Clinical Laboratory of Tongji Hospital, Wuhan, China: Hello George, recently we’ve met two or three cases from paediatrics with unexplained massively elevated D-dimer. In these cases, PT and PTT were normal, levels of fibrinogen were decreased (about 1.0-1.5g/L), different D-dimer reagents (STAGO AND IL) got consistent results, levels of rheumatoid factors were normal, clot and […]

Back to the ELT

In follow-up to Cassandra McGeachy’s August 7 question on the euglobulin lysis time (ELT), I’ve found two references for upgraded ELT methods that may be helpful.They are: Cellai AP. Lami D, Magi A, et al. Assessment of fibrinolytic activity by measuring the lysis time of a tissue factor-induced clot: a feasibility evaluation. Clin Appl Thromb Hemost 2010;16:337–44. […]

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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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