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D-Dimer

A D-dimer is an asymmetrical carbon compound fragment formed after thrombin converts fibrinogen to fibrin, factor XIIIa stabilizes it into a clot, and plasma acts on the cross-linked, or clotted, fibrin. The test is specific for fibrinolysis because it confirms the presence of fibrin split products.

Purpose

• To diagnose disseminated intravascular coagulation (DIC).
• To differentiate subarachnoid hemorrhage from a traumatic lumbar puncture in spinal fluid analysis.

Patient preparation

• Obtain the patient's history of hematologic diseases, recent surgery, and the results of other tests performed.
• Explain to the patient that the test is used to determine if the blood is clotting normally.
• Tell him that the test requires a blood sample. Explain who will perform the venipuncture and when.
• Reassure him that drawing a blood sample will take less than 3 minutes.
• Explain that he may feel slight discomfort from the tourniquet pressure and the needle puncture

Procedure and posttest care

• Perform a venipuncture and collect the sample in a 5-ml blue-top tube.
• For a spinal fluid analysis, the sample is collected during a lumbar puncture and placed in a plastic vial.
• Apply pressure to the venipunclure site for 5 minutes or until bleeding stops.
• If a hematoma develops at the venipuncture site, apply warm soaks.

Precautions

• Completely fill the collection tube, invert it gently several times, and send it to the laboratory immediately.
• For a patient with coagulation problems, you may need to apply additional pressure at the venipuncture site to control bleeding.

Reference values

Normal D-dimer test results are negative or < 250 ug/ml).

Abnormal findings

Increased D-dimer values may indicate DIC, pulmonary embolism, arterial or venous thrombosis, neoplastic disease, pregnancy (late and postpartum), surgery occurring up to 2 days before testing, subarachnoid hemorrhage (spinal fluid only), or secondary fibrinolysis.

Interfering factors

• Failure to fill the collection tube completely or to send the sample to laboratory immediately.
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• Hemolysis due to rough handling of the sample.
• High rheumatoid factor titers or increased CA-125 levels (possible false­positive).
• Spinal fluid analysis in infants under age 6 months (possible false-negative).

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