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Diagnosis of disseminated intravascular coagulation. Role of D-dimer
J M Carr1, M McKinney, J McDonagh
1Department of Pathology, Beth Israel Hospital, Boston, Massachusetts 02215.
Insights
Diagnosing disseminated intravascular coagulation (DIC) involves detecting D-dimer. Combining sensitive fibrin degradation product (FDP) screening with specific D-dimer confirmation maximizes diagnostic accuracy for DIC.
Area of Science:
- Hematology
- Clinical Chemistry
- Diagnostic Medicine
Background:
- Disseminated intravascular coagulation (DIC) is a life-threatening condition characterized by abnormal thrombin and plasmin generation.
- D-dimer, a cross-linked fibrin degradation fragment, serves as a key biomarker indicating these processes.
Purpose of the Study:
- To evaluate the diagnostic utility of D-dimer testing compared to fibrin(ogen) degradation products (FDPs) in patients at risk for DIC.
- To determine the optimal strategy for maximizing sensitivity and specificity in DIC diagnosis.
Main Methods:
- Immunoblotting was used as the gold standard for D-dimer detection.
- Latex agglutination assays for FDPs and D-dimer were compared against immunoblotting.
- Study included 58 patients at risk for DIC and 7 healthy controls.
Main Results:
- D-dimer was identified in 33 patients with DIC via immunoblotting.
- FDP measurement demonstrated high sensitivity but low specificity.
- D-dimer measurement showed lower sensitivity but high specificity.
Conclusions:
- A combined approach of sensitive FDP screening followed by specific D-dimer confirmation yielded 100% predictive value in this cohort.
- D-dimer is a valuable confirmatory test for the highly sensitive FDP assay in the laboratory diagnosis of DIC.
Abstract:
Detection of the cross-linked fibrin degradation fragment, D-dimer, in patients at risk for disseminated intravascular coagulation (DIC) is strong evidence for the diagnosis. D-dimer confirms that both thrombin generation and plasmin generation have occurred. Patients at risk for DIC (58) and normal controls (7) were studied. Thirty-three patients had DIC--with fragment D-dimer identified in their serum by immunoblotting. Latex agglutination measurements of fibrin(ogen) degradation products (FDPs) and D-dimer were compared with immunoblotting in the detection of D-dimer. FDP measurement was extremely sensitive but not specific. D-dimer measurement was less sensitive but highly specific. Used in tandem, screening with FDP and confirming with D-dimer, sensitivity and specificity were maximized, rendering a predictive value of a confirmed FDP of 100% in this cohort. D-dimer is a valuable adjunct for the laboratory diagnosis of DIC but is most appropriately used as a confirmatory test for the very sensitive FDP test.