Markedly Elevated D-dimer in an Infant

Markedly Elevated D-dimer in an Infant
George Fritsma
Aug 6, 2020 7:48am

A 4 month old girl was being prepped for surgery for a neural tube defect. All lab results were normal except her D-dimer result, which was greater than 20,000 ng/mL FEUs. The girl was in apparent good health, but the surgeon postponed surgery. The test was repeated after three days and the new D-dimer result was greater than 11,000 ng/mL FEUs. The usual reference limit for D-dimer is 500 ng/mL. What might have caused her implausibly elevated D-dimer?

Please click on "Comments" for your response or send to george@fritsmafactor.com.

Fibrinolysis, Specimen Management
2 Comments

A 4 month old girl was being prepped for surgery for a neural tube defect. All lab results were normal except her D-dimer result, which was greater than 20,000 ng/mL FEUs. The girl was in apparent good health, but the surgeon postponed surgery. The test was repeated after three days and the new D-dimer result was greater than 11,000 ng/mL FEUs. The usual reference limit for D-dimer is 500 ng/mL. What might have caused her implausibly elevated D-dimer?

Please click on "Comments" for your response or send to george@fritsmafactor.com.

By Coag Research Dave McGlasson
Aug 8, 2020 1:03pm
Of course we would always ask for a repeat specimen first. But having the second result still be astronomically elevated is a puzzle. A rheumatoid factor presence could be possible but unlikely in a 4 month old. I have to believe that maybe a pre-analytical error by the collection team might be an issue like clotted specimens order of draw, or wrong tube?
By George Fritsma
Aug 15, 2020 1:41pm
George, I’m not much for responding to posts. But for a child with markedly elevated D-dimer I’d be really worried about SARS-CoV-2. What part of the country? Best, Peter Saunders.
Thank you, Peter, we considered this possibility but found the child remains in otherwise good health, though never actually tested for Covid. Also, the numbers seem elevated to levels incompatible with life.

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