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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.
Summary
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.