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 help distinguish between DIC and liver disease. The patient already has an elevated VIII. Spherocytes should be looked at, also, since the PLT count, is rising slowly I would check for platelet clumps. Regarding TEG results, maybe this publication will help: Shah NL, Xavier E, Northup PG, et al. The use of thromboelastography, platelets, and INR in a clinical model for bleeding risk in cirrhotic patients. Gastroenterology. 2009;136(5 Supp 1):A795.
On January 16, Donna adds, “The only other issue is that D-dimer elevates for just about anything- inflammation/sepsis, so in reality an elevated D-dimer means little regarding a clot since we really use it for its negative predictive value, and everything- (sepsis, inflammation, MI, pregnancy, etc)- good test, needs the right situation!
Thanks for your input and the citation, Donna, this is very helpful. Geo.