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[Persistent discrepancy between FDP and D-dimer in a patient with acute leukemia]
N Sato1, H Takahashi, K Nikuni
1First Department of Internal Medicine, Niigata University School of Medicine.
Abstract:
In a patient with acute myeloblastic leukemia, serum fibrinogen/fibrin degradation products (FDP) were markedly elevated to 54.91 micrograms/ml, but plasma D-dimer was only slightly elevated (1.44 micrograms/ml). FDP in plasma measured by a method using monoclonal antibody specific to FDP was less than 5 micrograms/ml. Gradual reduction of blastic cells was obtained with the therapy of low-dose cytarabine, G-CSF and etoposide. The serum FDP increased up to 71.74 micrograms/ml accompanied with a transient elevation of D-dimer, and subsequently declined without any anticoagulant therapy. However, a discrepancy between serum FDP and plasma D-dimer lasted for a long time. In this case persistent acceleration of coagulation and fibrinolysis which may result in the elevation of serum FDP was not observed, suggesting that the greater part of increased FDP didn't reflect the true FDP formed by plasmin. There were possibilities that elevated serum FDP values were also caused by the presence of soluble fibrin, unclottable fibrinogen and the degradation products by nonplasmic proteinases. Simultaneous measurements of FDP and D-dimer are useful for a more accurate evaluation of hyperfibrinolytic states and to avoid possible misinterpretations due to falsely positive FDP.
Insights
In acute myeloblastic leukemia, serum fibrinogen/fibrin degradation products (FDP) can be falsely elevated. Simultaneous D-dimer testing helps accurately assess hyperfibrinolytic states and avoid misinterpretation.
Area of Science:
- Hematology
- Clinical Chemistry
Background:
- Acute myeloblastic leukemia (AML) can present with complex hemostatic abnormalities.
- Assessing hyperfibrinolysis is crucial for patient management.
Observation:
- A patient with AML showed markedly elevated serum fibrinogen/fibrin degradation products (FDP) but only slightly elevated plasma D-dimer.
- Serum FDP levels fluctuated during therapy, with a persistent discrepancy compared to plasma D-dimer.
- Standard FDP assays indicated significantly higher levels than those measured by a monoclonal antibody specific to FDP.
Findings:
- The elevated serum FDP levels in this AML case likely did not solely reflect plasmin-generated FDP, suggesting other contributing factors.
- Potential causes for elevated serum FDP include soluble fibrin, unclottable fibrinogen, and non-plasmic proteinase degradation products.
- A discrepancy between serum FDP and plasma D-dimer persisted, indicating a complex coagulation and fibrinolysis state.
Implications:
- Simultaneous measurement of FDP and D-dimer is essential for accurate evaluation of hyperfibrinolytic states in AML.
- Relying solely on serum FDP assays may lead to misinterpretation of hyperfibrinolytic activity.
- Understanding the source of elevated FDP is critical for appropriate clinical decision-making in hematological malignancies.