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Test NameD-Dimers
Used ForDiagnosis of intravascular coagulation and fibrinolysis, also known as disseminated intravascular coagulation, especially when combined with clinical information and other laboratory test data (eg, platelet count, assays of clottable fibrinogen and soluble fibrin monomer complex, and clotting time assays-prothrombin time and activated partial thromboplastin time). Excluding the diagnosis of acute pulmonary embolism or deep vein thrombosis, particularly when results of a sensitive D-dimer assay are combined with clinical information, including pretest disease probability.
MethodImmunoassay Turbidimetric
AliasesFibrinogen degradation products (FDP). Cross linked fibrin degradation products (XDP)
Specimen TypeCitrate (blue)
Volume of sampleMust be filled exactly to the fill line on the tube.
Refrigerated stability1 day
Interfering substancesGross Haemolysis. Lipaemia can cause under estimation of results. Raised Rheumatoid Factor (RF) can lead to an over-estimation of D-dimer level.
Clinical InformationThrombin, the terminal enzyme of the plasma procoagulant cascade, cleaves fibrinopeptides A and B from fibrinogen, generating fibrin monomer. Fibrin monomer contains D domains on each end of the molecule and a central E domain. Most of the fibrin monomers polymerise to form insoluble fibrin, or the fibrin clot, by repetitive end-to-end alignment of the D domains of 2 adjacent molecules in lateral contact with the E domain of a third molecule. The fibrin clot is subsequently stabilised by thrombin-activated factor XIII, which covalently cross-links fibrin monomers by transamidation, including dimerisation of the D domains of adjacently polymerised fibrin monomers. The fibrin clot promotes activation of fibrinolysis by catalysing the activation of plasminogen (by plasminogen activators) to form plasmin enzyme. Plasmin proteolytically degrades cross-linked fibrin, ultimately producing soluble fibrin degradation products of various sizes that include cross-linked fragments containing neoantigenic D-dimer (DD) epitopes. Plasmin also degrades fibrinogen to form fragments X, Y, D, and E. D-dimer immunoassays use monoclonal antibodies to DD neoantigen and mainly detect cross-linked fibrin degradation products, whereas the fibrino(geno)lytic degradation products X, Y, D, and E and their polymers may be derived from fibrinogen or fibrin. Therefore, the blood content of D-dimer indirectly reflects the generation of thrombin and plasmin, roughly indicating the turnover or activation state of the coupled blood procoagulant and fibrinolytic mechanisms.
InterpretationD-dimer values < or = 500 ug/L are normal. Within the reportable normal range, values may reflect the activation state of the procoagulant and fibrinolytic systems, but the clinical utility of such quantitation is not established. A normal D-dimer result (< or =500ug/ml) has a negative predictive value of approximately 95% for the exclusion of acute pulmonary embolism (PE) or deep vein thrombosis when there is low or moderate pretest PE probability. Increased D-dimer values are abnormal but do not indicate a specific disease state. D-dimer values may be increased as a result of; Clinical or subclinical disseminated intravascular coagulation/intravascular coagulation and fibrinolysis; Other conditions associated with increased activation of the procoagulant and fibrinolytic mechanisms such as recent surgery, active or recent bleeding, haematomas, trauma, or thromboembolism; Association with pregnancy, liver disease, inflammation, malignancy or hypercoagulable (procoagulant) states. The degree of D-dimer increase does not definitely correlate with the clinical severity of associated disease states.
Turnaround1h
Retention Time7 days
ReferencesMayo Clinic Laboratories
Lab Tests On Line
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