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D-DIMER

Lung
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Report in 4Hrs

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At Home

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No Fasting Required

Details

Test for fibrin degradation; elevated in deep vein thrombosis, pulmonary embolism, and DIC.

₹549₹1,650

67% OFF

D-Dimer Test Information Guide

  • Why is it done?
    • D-dimer is a fibrin degradation product measured to assess abnormal blood clotting and fibrinolysis (breakdown of blood clots)
    • Primarily used to rule out or diagnose thromboembolic conditions, particularly deep vein thrombosis (DVT) and pulmonary embolism (PE)
    • Ordered when patients present with symptoms suggestive of thrombosis: leg swelling, chest pain, shortness of breath, or acute respiratory distress
    • Used as a screening tool in emergency departments and acute care settings due to its high negative predictive value
    • May be ordered to monitor disseminated intravascular coagulation (DIC), acute thrombotic events, and post-operative complications
    • Typically performed acutely when thromboembolism is clinically suspected, requiring rapid turnaround time
  • Normal Range
    • Normal D-dimer levels: < 0.5 μg/mL (micrograms per milliliter) or < 500 ng/mL (nanograms per milliliter)
    • Reference ranges vary by laboratory and testing methodology (immunoassay, ELISA, latex agglutination, or turbidimetric assays)
    • Negative result (normal): D-dimer < cutoff value, effectively rules out thromboembolism with high sensitivity (>95%)
    • Positive result (elevated): D-dimer > cutoff value, suggests possible thrombotic event but has low specificity; further imaging required
    • Borderline/Gray zone: Some laboratories report intermediate ranges that require clinical correlation and potentially repeated testing
    • Units of measurement: Micrograms per milliliter (μg/mL), nanograms per milliliter (ng/mL), or fibrinogen equivalent units (FEU)
  • Interpretation
    • Negative D-dimer (<0.5 μg/mL): Excellent negative predictive value for DVT/PE; thromboembolism is unlikely; imaging studies (CT angiography, ultrasound) typically not warranted unless clinical suspicion remains very high
    • Mildly elevated D-dimer (0.5-1.0 μg/mL): Requires clinical correlation with pretest probability; imaging may be considered if clinical suspicion is moderate to high
    • Significantly elevated D-dimer (>1.0 μg/mL): Supports further imaging investigation (CT angiography, compression ultrasound, V/Q scan); increased likelihood of thromboembolism or alternative acute conditions
    • Very high D-dimer (>5.0 μg/mL): Indicates significant thrombin generation and fibrinolysis; suggests acute thrombosis, DIC, severe infection, malignancy, or recent surgery
    • Factors affecting D-dimer levels:
    • Increases (false positives): Pregnancy and postpartum period, cancer and malignancy, inflammation or infection, recent surgery or trauma, age >60 years, myocardial infarction, stroke, end-stage renal disease
    • Clinical significance: D-dimer is highly sensitive but not specific; negative D-dimer is more useful for ruling out thromboembolism than positive result is for confirming it; must always be interpreted within clinical context
    • Pretest probability integration: Used in conjunction with clinical assessment tools (Wells score, PERC criteria) to guide diagnostic workup and reduce unnecessary imaging
  • Associated Organs
    • Primary organ systems involved:
    • Vascular system: Deep leg veins, pulmonary arteries, peripheral vasculature, coronary arteries
    • Liver: Primary site of D-dimer production and clearance; dysfunction may affect interpretation
    • Lungs: Site of PE manifestation; target organ for pulmonary embolic events
    • Kidneys: May be affected by PE or thrombotic events; renal dysfunction can influence test results
    • Conditions associated with abnormal D-dimer:
    • Thromboembolism: Deep vein thrombosis (DVT), pulmonary embolism (PE), arterial thrombosis, cerebral venous sinus thrombosis
    • Coagulopathies: Disseminated intravascular coagulation (DIC), thrombotic thrombocytopenic purpura (TTP), hemolytic uremic syndrome (HUS)
    • Cardiovascular events: Acute myocardial infarction, stroke, unstable angina, aortic dissection
    • Malignancy: Various cancers associated with hypercoagulability and elevated D-dimer
    • Infection and inflammation: Sepsis, pneumonia, meningitis, inflammatory bowel disease, rheumatoid arthritis
    • Obstetric complications: Eclampsia, placental abruption, amniotic fluid embolism
    • Potential complications of abnormal results:
    • If thromboembolism confirmed: Risk of hemodynamic instability, shock, organ dysfunction, sudden death (especially PE)
    • Chronic sequelae: Post-thrombotic syndrome, pulmonary hypertension, chronic thromboembolic disease
    • Recurrent events: Increased risk of recurrent thromboembolism if underlying thrombophilia or predisposing factors persist
  • Follow-up Tests
    • If D-dimer is negative:
    • Generally, no further imaging or testing required if clinical suspicion is low to moderate
    • If clinical suspicion remains very high despite negative D-dimer, consider imaging (CT angiography, venous ultrasound)
    • If D-dimer is positive or elevated:
    • Computed tomography angiography (CTA): Definitive imaging for suspected pulmonary embolism
    • Compression ultrasound: First-line imaging for suspected deep vein thrombosis
    • Ventilation/perfusion (V/Q) scan: Alternative imaging if CTA contraindicated
    • Prothrombin time (PT) and activated partial thromboplastin time (aPTT): Assess coagulation profile if coagulopathy suspected
    • Platelet count and fibrinogen: Evaluate for disseminated intravascular coagulation (DIC)
    • Thrombophilia workup: Factor V Leiden, prothrombin gene mutation, antithrombin III, protein C and S, antiphospholipid antibodies (if recurrent thrombosis)
    • Troponin and B-type natriuretic peptide (BNP): Assess right ventricular strain and myocardial injury in PE
    • For DIC suspicion:
    • Serial D-dimer measurements: Monitor trend over time; progressively rising levels suggest ongoing fibrinolysis
    • PT, aPTT, fibrinogen, platelets, thrombin time: Complete coagulopathy assessment
    • Monitoring frequency:
    • Acute setting: May repeat D-dimer or proceed directly to imaging based on clinical presentation
    • Chronic monitoring: Not routinely recommended after thrombosis diagnosis; D-dimer remains elevated for weeks and does not guide anticoagulation duration
    • Post-treatment: Normalization typically occurs 4-6 weeks after thrombotic event resolution
  • Fasting Required?
    • Fasting requirement: NO
    • D-dimer testing does not require fasting; patient may eat and drink normally before blood draw
    • Timing: Test can be performed at any time of day; no time-of-day effect on results
    • Medications to avoid:
    • No medications need to be discontinued prior to D-dimer testing
    • Anticoagulants (warfarin, direct oral anticoagulants, heparin) do not interfere with D-dimer test and may be continued
    • Antiplatelet agents (aspirin, clopidogrel) do not affect D-dimer results
    • Patient preparation:
    • Remain calm for 5-10 minutes prior to blood draw to reduce stress-induced elevations in clotting markers
    • Blood collection: Venipuncture into sodium citrate-containing tube (blue-top tube) with proper fill volume for accurate testing
    • Sample stability: Specimens should be transported to laboratory promptly; some assays require room temperature storage, others refrigeration
    • Emergency situations: Test can be performed emergently; results often available within 30-60 minutes in acute care settings

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