D-Dimer, Quantitative


Sunquest Code:DD  
Epic Code:LAB313Epic Name:D-Dimer Quantitative
Synonyms:Fibrin D-Dimer; Fibrin Split Products; DD; D Dimer
Methodology:Immuno-turbidimetric
CPT Code:85379
Turnaround Time:Performed 24 hours/day; results are reported within 3 hours.
Associated Links:

Specimen Collection and Processing for Coagulation Specimens



Collection Instructions

Specimen:Blood
Optimal Volume:2.7 mL (in 3 mL tube) - filled to fill line on the tube
Minimum\Peds Volume:1.8 mL (in 2 mL tube) - filled to fill line on the tube
Collection Instructions:If the patient's hematocrit is greater than 55%, contact laboratory to obtain a special tube. If using a butterfly needle, a waste tube must be collected before the blue top.
After Care:If the patient has a coagulation abnormality, apply direct pressure to the puncture site for 10 minutes; apply a pressure dressing. Instruct the patient to leave the bandage on for 12 hours.
Causes for Rejection:Underfilled tubes, overfilled tubes, clotted specimens, specimens collected in 3.8% buffered citrate.
Whole blood specimen greater than 8 hours old or not processed appropriately within 8 hours of collection.


Processing and Shipping

Specimen Processing:Send whole blood or platelet poor plasma. See Associated Link for additional processing instructions.
Shipping Instructions:Ship whole blood specimens at room temperature. Whole blood specimens must arrive within 8 hours. If greater than 8 hrs is required for transport, follow specimen processing instructions and ship frozen plasma on dry ice.
Test Performed at or Referral Lab Coagulation  (UMMC-East Bank, Oxboro Bloom, Fairview Lakes - FLMC, Fairview Ridges - FRH, Fairview Northland - FNMC, Fairview Southdale - FSH, UMMC/UMMCH-West Bank)


Interpretive

Reference Range:
0.5 ug/mL FEU or less.   For patients 50 years of age or older, the application of age-adjusted cut-off values for D-Dimer may increase the specificity without significant effect on sensitivity. The literature suggested calculation age adjusted cut-off in ug/L = age in years x 10 ug/L. The results in this laboratory are reported as ug/mL rather than ug/L. The calculation for age adjusted cut off in ug/mL= age in years x 0.01 ug/mL. For example, the cut off for a 76 year old male is 76 x 0.01 ug/mL = 0.76 ug/mL (760 ug/L)   M Righini et al. Age adjusted D-dimer cut-off levels to rule out pulmonary embolism: The ADJUST-PE Study. JAMA 2014;311:1117-1124. HJ Schouten et al. Diagnostic accuracy of conventional or age adjusted D-dimer cutoff values in older patients with suspected venous thromboembolism. Systemic review and meta-analysis. BMJ 2013:346:f2492.  
Use:
This D-Dimer assay is intended for use in conjunction with a clinical pretest probability assessment model to exclude pulmonary embolism (PE) and deep venous thrombosis (DVT) in outpatients suspected of PE or DVT. The cut-off value is 0.5 ug/mL FEU.   The D-Dimer is a marker of the breakdown of a cross-linked fibrin clot (i.e., fibrinolysis) and an indirect marker of clot formation. Elevated levels of D-Dimer are present in a wide variety of disorders known to be associated with activation of coagulation: Some of these include:
  •           Venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE).
  •           Disseminated intravascular coagulation (DIC)
  •           Hemorrhages
  •           Infection
  •           Liver disease
  •           Malignancy
  •           Post-operative period
  •           Pregnancy
  •           Renal failure
  •           Surgery
  •           Vaso-occlusive sickle cell crisis
   


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