A message from “Dchrist” at Mercy Hospital in Chicago:
What is the clinical rationale, if any, for offering both a qualitative and quantitative D-dimer assay in the main hospital lab?
Hello, and thank you for your question. It may be that your director retains the qualitativeassay for a quick turn-around to help diagnose disseminated intravascular coagulation (DIC), in which D-dimer levels become markedly elevated. The quantitative assay, which is also speedy and could be used for both applications, is primarily used to rule outvenous thromboembolism in symptomatic patients who have a low pre-assay clinical score for thrombosis. Here is a small study comparing qualitative and quantitative point-of-care D-dimer assays in thromboembolism: Geersing GJ, Janssen KJ, Oudega R, et al. Excluding venous thromboembolism using point of care D-dimer tests in outpatients: a diagnostic meta-analysis. BMJ 2009; 339:b2990. doi: 10.1136/bmj.b2990.
I have a similar question. if you have both, shouldn’t you r
I have a similar question. if you have both, shouldn’t you replace the less specific. Another possibility is to use semiquantitative in DIC which is enough together PT, APTT and fibrinogen.
Added by George: I agree that you should use the more specific assay, which is the quantitative assay. However, it is true, the semiquantitative is diagnostic for DIC with the prothrombin time, partial thromboplastin time and fibrinogen.