D-dimer in COVID-19

D-dimer in COVID-19

2020-06-18 359
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What is D-dimer?

D-dimer in COVID-19

D-dimer is a breakdown product of blood clots.

It is normally undetectable unless the body is

forming and breaking down blood clots. The

presence of D-dimer signals inappropriately

high levels of clotting.

What is D-dimer test ordered?

The measurement of D-dimer is mainly used

to help rule out clotting formation and to help

diagnose conditions related to thrombosis such

as deep vein thrombosis (DVT), pulmonary

embolism (PE), and disseminated intravascular

coagulation (DIC). The D-dimer test can also

be used to monitor treatment of DIC and

excessive clotting condition

Figure: Formation of FDP and D-dimer in fibrinolysis

What does it mean if the sample tests positive for D-dimer?

A positive D-dimer result indicates that there may be significant blood clot (thrombus) formation and breakdown in the body, but it does not tell the location or cause. For example, it may be due to a venous thromboembolism (VTE) or DIC. Typically, the D-dimer level is very elevated in DIC.

However, an elevated D-dimer does not always indicate the presence of a clot because a number of other factors can cause an increased level. Elevated levels may also be seen in conditions such as recent surgery, trauma, infection, heart attack, and some cancers or conditions in which fibrin is not cleared normally, such as liver disease. Fibrin is also formed and broken down during pregnancy, so that may result in an elevated D-dimer level.

What does it mean if the sample tests negative for D-dimer?

A normal or 'negative' D-dimer result (D-dimer level is below a predetermined cut-off threshold) means that it is most likely that the person tested does not have an acute condition or disease causing abnormal clot formation and breakdown.

When used to monitor DIC treatment, decreasing levels indicate that treatment is effective while increasing levels may indicate that treatment is not working.

When bleeding, the body creates a blood clot to limit and stop the bleeding. This produces threads of a protein called fibrin, which crosslink together to form a fibrin net.

Once healed and the clot is no longer needed, the body uses an enzyme called plasmin to break the clot (thrombus) into small pieces so that it can be removed. The fragments of the disintegrating fibrin in the clot are called fibrin degradation products (FDP), which consist of variously sized pieces of crosslinked fibrin. One of the final fibrin degradation products produced is D-dimer.


'D-dimer in COVID-19     Higher concentrations of D-dimer were significantly associated 

with poor prognosis (of COVID-19).         D-dimer in COVID-19

D-dimer in COVID-19

source: shutterstock

Diagnosis and Treatment Protocol for Novel Coronavirus Pneumonia (Trial Version 7)

– National Health Commission of the People’s Republic of China

IV. Clinical Characteristics

2. Laboratory findings

“Most patients have elevated C-reactive protein and erythrocyte sedimentation rate and normal procalcitonin. In severe cases, D-dimer increases and peripheral blood lymphocytes progressively decrease. Severe and critically ill patients often have elevated inflammatory factors.”

D-dimer in COVID-19

LI, Hui, et al. SARS-CoV-2 and viral sepsis: observations and hypotheses. The Lancet, 2020.

“Studies have revealed that 71·4% of non-survivors of COVID-19 matched the grade of overt disseminated intravascular coagulation (DIC) (≥5 points according to the International Society on Thrombosis and Haemostasis criteria) and showed abnormal coagulation results during later stages of the disease; particularly increased concentrations of D-dimer and other fibrin degradation products were significantly associated with poor prognosis.”

D-dimer in COVID-19

TANG, Ning, et al. Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. Journal of Thrombosis and Haemostasis, 2020, 18.4: 844-847.

'...the non-survivors revealed significantly higher D-dimer and fibrin degradation product (FDP) levels, longer prothrombin time and activated partial thromboplastin time compared to survivors on admission (P < 0 .05)'

D-dimer in COVID-19

Figure: Dynamic profile of D-dimer in patients with novel coronavirus pneumonia (NCP)

CUI, Songping, et al. Prevalence of venous thromboembolism in patients with severe novel coronavirus pneumonia. Journal of Thrombosis and Haemostasis, 2020.

“A total of 20 (25%) patients with severe NCP developed lower extremity venous thrombosis, of which 8 patients died. The venous thromboembolism (VTE) group had older age, lower lymphocyte counts, longer APTT, and higher D-dimer (5.2 ± 3.0 versus 0.8 ± 1.2 mg/L, P < 0.001). Moreover, the D-dimer of the two groups was not within the normal range.”

D-dimer in COVID-19



For determination of D-dimer

D-dimer in COVID-19

D-dimer in COVID-19

D-dimer in COVID-19

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