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D-dimer Elevated 6 Months

Dear George, I am a 42 year old African American women in fairly good health. I am obese and I live a partly active life. I went to the emergency room back in January of this year for chest pain and palpitations. While there they did a D-dimer test and a chest CT scan. I was told that my CT scan was normal but some lung nodules were noticed and my D-dimer was elevated. I was told to follow up with my doctor.

I followed up with my doctor and he repeated the D-dimer test and it was still elevated. It went from 950 to 1000 in a short time. In the mean time my doctor sent me to a hematologist whom had no idea why the D-dimer went up. This was a couple of months after going to the ER. She retested the D-dimer and it went down some but was still elevated. She had no idea and referred me to a cancer center. I was retested this month and my D-dimer is 1100 now. The cancer center said she had no idea why the D-dimer is so high. I have a ultra sound of my legs and arms, all normal. I have had CT scan of my chest. I am at a loss and am very afraid that these doctors are missing something. Any advice you can give will help me.

Hello, and thank you for yout question. Doctors order the D-dimer test for two reasons. The first is to monitor a serious condition called disseminated intravascular coagulation (DIC), which is an adverse clotting response to acute, life-threatening illness. In DIC the D-dimer may go as high as 10,000 fibrinogen equivalent units (FEUs), whereas the normal limit for the D-dimer is approximately 500 FEUs. You definitely do not have DIC.

The second reason is to rule out blood clots in your veins, called venous thromboembolism (VTE). These clots can occur in leg veins, called deep vein thrombosis (DVT) or in the lungs, called pulmonary emboli (PE). PE is especially dangerous, so any time someone experiences chest pain the doctors will order the D-dimer (along with the usual heart attack tests).

Notice that doctors use the D-dimer only to rule out DVT or PE. This means they are looking for a D-dimer result less than 500 FEUs. If the D-dimer is low, they need not order a CT scan or ultrasound of the legs or lungs. However, doctors cannot use the D-dimer to confirm DVT or PE. This is because the D-dimer test becomes elevated in any mild or moderate inflammatory condition. Medical laboratory scientists call the D-dimer a “promiscuous” assay because it rises during infections, diabetes, a form of “pre-diabetes” called metabolic syndrome, after an injury or surgery, in arthritis, and many other inflammatory conditions. Cancer is an inflammatory condition, so your hematologist was wise to have you tested for cancer, if only to reduce any possible anxiety. Your negative results are reassuring.

You describe yourself as obese. Obesity is an inflammatory condition, as the cells of adipose (fat) tissue release inflammatory chemicals called cytokines. Your doctor may conclude that your elevated D-dimer is related to obesity and may choose to counsel you to go on a diet. Most of us get that advice from our physicians at every visit! Meanwhile, however, your doctor may choose to look for another of the myriad sources of mild chronic inflammation.

To conclude, you need not worry about your chronically elevated D-dimer, however your physician may choose to order additional laboratory tests to pinpoint the inflammatory condition that may be responsible. Please feel free to contact me at [email protected] if you have any additional questions or follow-up information, and best wishes for your good health.

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