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D-Dimer Testing: Laboratory Aspects and Current Issues
Jecko Thachil1, Giuseppe Lippi2, Emmanuel J Favaloro3
1Department of Haematology, Manchester Royal Infirmary, Oxford Road, M13 9WL, Manchester, UK. jecko.thachil@cmft.nhs.uk.
Insights
D-dimer testing aids in ruling out venous thromboembolism and diagnosing coagulation disorders. However, understanding its technical aspects and harmonizing assays are crucial for reliable clinical use.
Area of Science:
- Clinical Biochemistry
- Hematology
- Diagnostic Medicine
Background:
- D-dimer is a common coagulation test for venous thromboembolism (VTE) diagnosis.
- Appropriate D-dimer use reduces unnecessary radiological imaging.
- It is also vital in diagnosing disseminated intravascular coagulation (DIC).
Purpose of the Study:
- To review D-dimer physiology and formation.
- To discuss current D-dimer assessment methods.
- To highlight challenges and the need for assay harmonization.
Main Methods:
- Literature review of D-dimer physiology.
- Analysis of D-dimer detection methodologies.
- Discussion of clinical and laboratory challenges.
Main Results:
- D-dimer testing effectively aids VTE rule-out and DIC diagnosis.
- Technical issues and lack of assay harmonization pose concerns.
- Understanding D-dimer formation and limitations is essential.
Conclusions:
- D-dimer is a valuable diagnostic tool when used appropriately.
- Addressing technical variability and harmonizing assays are critical.
- Further research and standardization are needed for optimal D-dimer utility.
Abstract:
D-dimer has become one of the commonly requested coagulation tests, especially in the venous thromboembolism rule out setting. Appropriate D-dimer testing has significantly decreased the number of radiological investigations in this clinical scenario. D-dimer testing also plays an important role in the diagnostic process of the systemic coagulation disorders, especially disseminated intravascular coagulation in conjunction with other coagulation tests. However, widespread D-dimer testing without good understanding of the technical issues related to the test has recently caused some concerns. This review aims to address the basic physiology of D-dimer formation, the different methods available for its routine assessment, the current problems that both clinicians and laboratory scientists face with this test, and the important need for harmonization of commercial immunoassays.
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