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Discussion

D-Dimer Scare!!!

I was seen at the ER a few weeks ago with an elevated D-Dimer (1.06). A little over a week later I asked my MD to redraw. It was drawn in her office then shipped to the hospital to be tested and the level read (10.2). I freaked out and went to the ER that same day and they redrawn the D-Dimer and it was 1.32, which is still increasing. I have had CT Scans of the Chest and VQ Scans and the VQ Scans came back normal. The CT Scans were performed improperly. Thats why they ended up doing the VQ Scans. I have had it done twice in a three week period and they can't find anything. I have had a venous doppler performed on both legs. That was normal. I was told that infection, injury, or surgery within the past 3 months could cause it to be elevated. I have had my left wrist lanced and it tested positive for MRSA. Can this be the cause? Can someone please help me find the next step in order to ease my mind of this situation?

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A positive D-dimer indicates the presence of an abnormally high level of fibrin degradation products in your body. It tells your doctor that there has been significant clot (thrombus) formation and breakdown in the body, but it does not tell the location or cause. An elevated D-dimer may be due to a VTE or DIC but it may also be due to a recent surgery, trauma, or infection. Elevated levels are also seen with liver disease, pregnancy, eclampsia, heart disease, and some cancers.

D-dimer concentrations may rise in the elderly, and false positives may be seen with high levels of rheumatoid factor (a protein seen in patients with rheumatoid arthritis). Substances such as high triglycerides, lipemia (a large amount of fats in the blood that can be caused by the patient consuming a greasy meal prior to testing), and bilirubin can also cause false positives as can hemolysis caused by improper collection and handling.

D-dimer is great to rule out DVT/VTE's (not high, probably not a DVT), but it is terrible predictive indicator with so many other causes of elevation.

Go back and see your doc...

This is going to sound condescending but, Take a valium and chill out. In my ED only about 10% of the elevated D-Dimers have DVT's or PE's. There are so many reasons for high levels. Things like triglycerides, biliruben, pregnancy, and a long list of others. 2 neg VQ scans, neg dopplers, and I'm assuming no symptoms. Well just sit down and have a true two way discusion with your doc.

A positive D-dimer indicates the presence of an abnormally high level of fibrin degradation products in your body. It tells your doctor that there has been significant clot (thrombus) formation and breakdown in the body, but it does not tell the location or cause. An elevated D-dimer may be due to a VTE or DIC but it may also be due to a recent surgery, trauma, or infection. Elevated levels are also seen with liver disease, pregnancy, eclampsia, heart disease, and some cancers.

D-dimer concentrations may rise in the elderly, and false positives may be seen with high levels of rheumatoid factor (a protein seen in patients with rheumatoid arthritis). Substances such as high triglycerides, lipemia (a large amount of fats in the blood that can be caused by the patient consuming a greasy meal prior to testing), and bilirubin can also cause false positives as can hemolysis caused by improper collection and handling.

When you quote verbatim, it is a good idea to cite your source.

http://www.labtestsonline.org/understanding/analytes/d_dimer/test.html

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