D-Dimer, Quantitative


Abbrev Code:DD   
Order Code:LAB313Order Name:D-Dimer Quantitative
Synonyms:Fibrin D-Dimer; Fibrin Split Products; DD; D Dimer
Methodology:Immuno-turbidimetric
CPT Codes: 85379 x1
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
Container:Blue Na Citrate, 3.2% - fill to fill line on 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  (Grand Itasca, Lakes, Northland, Oxboro Clinic, Range, Ridges, Southdale, St. John's, UMMC East Bank, UMMC/UMMCH-West Bank, Woodwinds)


Interpretive

Critical Range:Greater than 20.0 ug/mL FEU
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 vein thrombosis (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
  • Postoperative period
  • Pregnancy
  • Renal failure
  • Surgery
  • Vaso-occlusive sickle cell crisis


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