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D-dimer is a protein fragment produced when blood clots are broken down in the body. It is normally undetectable but levels rise when clots are forming and breaking down. The D-dimer test detects levels of this protein to help diagnose conditions involving blood clots, such as deep vein thrombosis and pulmonary embolism. The test involves mixing the blood sample with latex particles coated with antibodies for D-dimer, which will cause clumping if D-dimer is present above the reference level of 250 ng/mL. Both qualitative and quantitative D-dimer tests are used, with quantitative providing a more precise measurement.
D-dimer is a protein fragment produced when blood clots are broken down in the body. It is normally undetectable but levels rise when clots are forming and breaking down. The D-dimer test detects levels of this protein to help diagnose conditions involving blood clots, such as deep vein thrombosis and pulmonary embolism. The test involves mixing the blood sample with latex particles coated with antibodies for D-dimer, which will cause clumping if D-dimer is present above the reference level of 250 ng/mL. Both qualitative and quantitative D-dimer tests are used, with quantitative providing a more precise measurement.
D-dimer is a protein fragment produced when blood clots are broken down in the body. It is normally undetectable but levels rise when clots are forming and breaking down. The D-dimer test detects levels of this protein to help diagnose conditions involving blood clots, such as deep vein thrombosis and pulmonary embolism. The test involves mixing the blood sample with latex particles coated with antibodies for D-dimer, which will cause clumping if D-dimer is present above the reference level of 250 ng/mL. Both qualitative and quantitative D-dimer tests are used, with quantitative providing a more precise measurement.
small protein fragment present in the blood after a blood clot it is degraded by fibrinolysis. Introduction:
• D-dimer is one of the protein fragments produced
when a blood clot gets dissolved in the body. • It is normally undetectable or detectable at a very low level unless the body is forming and breaking down blood clots. • Then, its level in the blood can significantly rise. This test detects D-dimer in the blood Generation Of D-dimer From Cross-Linked Fibrin Reference Range
• D-dimer is the degradation product of cross linked
(by factor XIII) fibrin. It reflects ongoing activation of the haemostatic system. • The reference concentration of D-dimer is < 250 ng/mL, or < 0.4 mcg/mL. Indications
• Elevated level of D-Dimer are found in clinical
conditions such as: • Deep vein thrombosis • Pulmonary embolism • Disseminated intravascular coagulation Indications
• The D-Dimer level are rise during pregnancy
and high level are associated with complication. • Normal pregnancy is associated with alterations of the haemostatic system toward a hypercoagulable state. • Elevated markers of coagulation and fibrinolytic system activation, such as D-dimer, indicate increased thrombin activity and increased fibrinolysis following fibrin formation throughout pregnancy. Qualitative Method Material requirement:
• D-Dimer proteins in the sample bind to the specific
anti-D-Dimer antibody which is coated with latex particles, which react with fibrin D-Dimer or fragment D of fibrin but not with intact fibrinogen. As a result agglutination occur. Procedure:
• Bring all the reagents to room temperature.
• Place 20ul of sample in one circle of the test card and add similar quantity of sample into positive and negative control. • Add 20ul of latex reagent into each circle. • Use separate mixing rods for mixing the contents of each circle. • Start the timer. • Rotate the test card and note the agglutination between 180-200seconds. Procedure:
• Compare the agglutination pattern with those
produced by the positive and negative controls. The negative control will not give any agglutination but positive control result will give agglutination. ICT Method
• Now a days D-dimer is also qualitatively detected
through ICT strip available. Semi quantitative method:
• This is done only when the qualitative test is positive.
• For this purpose serially dilute 100ul of sample 1:2, 1:4 and 1:8. • Add 100ul saline solution in these three test tubes. • Mark the positions of sample dilutions on the test card and mix with the latex suspension. • Each dilution is tested similarly. • The D-dimer concentration may be determined from the following table: D-dimer Level (ng/ml) (ng/ml) Undiluted 1:2 1:4 1:8 <250 - - - - 250-500 + - - - 500-1000 + + - - 1000-2000 + + + - >2000 + + + + Interpretation:
• Agglutination occurs within 180-200 seconds for
sample containing greater than 250ng/ml D-dimer. • The mean level of D-dimer in a healthy population is between about 8 and 135 ng/ml, and neat plasma from normal healthy individuals should not give agglutination. • The circulatory half-life of D-dimer is about 12 hours. Quantitative D-dimer Assays
• Quantitative D-dimer assays have replaced semi-
quantitative methods in medical practice. When combined with clinical criteria, the finding of low D-dimer is useful for ruling out thrombosis and PTE early in the diagnostic work-up. • The Comparative Coagulation Laboratory is now offering a quantitative D-dimer test for animals in place of a semi- quantitative test method. A specific value, rather than concentration range, provides more precise monitoring for serial assessments of patient status. Testing algorithms that incorporate quantitative D-dimer may improve diagnostic accuracy for early identification of thrombosis Limitations
• False positive readings can be due to various causes:
• Liver disease, • High Rheumatoid Factor, • Inflammation, • Malignancy, • Trauma, • Pregnancy, • Recent surgery. Limitations • False Negative readings can occur if the sample is taken either too early after thrombus formation or if testing is delayed for several days. • Additionally, the presence of anti-coagulation can render the test negative because it prevents thrombus extension. References
• Freyburger G, Labrouche S. Comparabilty of D-dimer assays
in clinical samples. Seminars in Vasc Medicine 2005;5:328- 339. • Arnout J, Sales M, Arza B et al. Clinical management study of venous thromboembolism using HemosIL D-dimer. (abstr) ISTH, August 6-12, Sydney Australia, 2005. • Hart DJ, Hutchman G, Cuthbert RJG. Evaluation of an automated latex D-dimer immunoassay in the clinical assessment of suspected venous thromboembolism. Clin. Lab. Haem. 2002;24:171-174. • Stokol T, Brooks MB, Erb HN, Mauldin GE. D-dimer concentrations in healthy dogs and dogs with disseminated intravascular coagulation Am J Vet Res 2000;61:393-398.