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More on Chronically Elevated D-dimer

I [Geo] received this 2-1-24 email from a correspondent who had expressed concern for his isolated elevated D-dimer. This is an issue we’ve addressed in the past that prompted me to prepare a summary entitled Isolated Chronically Elevated D-dimer. Here’s the note:

Hello. We had email contact in 2023 and it was about a chronically elevated D-dimer, for which no cause could be found despite countless examinations. I think I was able to solve the puzzle, at least in my case. I went to the dentist and had a panoramic x-ray taken. It turned out that a wisdom tooth was extremely infected/inflamed. My D-dimer was 1.6 (reference range up to 0.5). This tooth was treated under a microscope in the root canal (because it holds a dental bridge) and was saved. A short time later my D-dimer dropped the first time since years under 1.0 to 0.7. The conclusion in my case: we wrote back then that my chronic gastritis (i.e. inflammation) was probably responsible for the increased D-dimer. It could also have been my liver hemangioma. But it looks as if even unknown (because there are no symptoms) tooth infections can be considered for increasing the D-Dimer. I wanted to share this with you because we had such nice email correspondence back then. I wish you all the best!

Comments (1)
Marijo Milic
Mar 6, 2024 7:22am

Dear Geo,
Since the method for determining D-dimers is immunochemical, it is susceptible to interferences specific to immunochemical reactions. A common cause of interference is heterophilic antibodies. Assay interference with heterophilic antibodies has been well described for hormones and tumor markers.
Here are some published articles on interference from heterophilic antibodies in D-dimer assay:

1. Lippi G, Ippolito L, Tondelli MT, Favaloro EJ. Interference from heterophilic antibodies in D-dimer assessment. A case report. Blood Coagul Fibrinolysis. 2014;25(3):277–9.
2. Çevlik T, Turkal R, Haklar G, Airikçi Ö. A case of falsely elevated D-dimer result. Turkish J Biochem. 2022;47(5):686–9.
3. Ozbalci D, Doguc DK, Yilmaz G, Ozturk O, Sirin FB, Akcam FZ. Interference of D-dimer levels from heterophilic antibody in COVID-19: A serious concern in treatment and follow-up of patients. Int J Lab Hematol. 2022;44(1):e13–6.
4. Wu Y, Xiao YX, Huang TY, Zhang XY, Zhou HB, Zhang XX, et al. What makes D-dimer assays suspicious–heterophilic antibodies? J Clin Lab Anal. 2019;33(2):1–7.
Yours sincerely, Marija Milic

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