D-Dimer in TrivandrumThe recently released IFCC-Guideline for COVID-19 strongly suggests D-Dimer tests for patients suffering from COVID-19. (1) Studies have revealed higher D-Dimer levels in the most severe cases of COVID in comparison to mild cases and healthy non-COVID patients. (2,3) Then, the D-Dimer concentration at admission was significantly higher than the range of reference for non-survivors of a study conducted by Pan and colleagues. (4) The first laboratory data results from around 28 000 COVID-19 patients revealed the most prominent abnormalities in the CRP and D-dimer. The levels of hospitalized patients increased with the severity of their hospitalization, which is in line with earlier research from China. (5) In a research conducted by Zhang and co. Including 241 Covid-19 patients (57 severe) and more than 220 healthy patients or those who are not COVID severe COVID-19 patients had abnormal platelet parameters and coagulation parameters, for example, the increase of D-Dimer. Platelets play a vital function in hemostasis and thrombosis However, they also play a role in the innate and adaptive immune systems. They are a source of inflammatory compounds such as chemokines and cytokines, and also have pathways to recognize pathogens. they can be targets of pathogens too. Viral infections can trigger platelet activation, activating disseminated intravascular blood coagulopathy and blood clotting. (6,7) Platelets express angiotensin-converting enzyme 2 (ACE2) and transmembrane serine protease 2 (TMPRSS2), crucial for SARS-CoV-2 cell entry. Zhang et al. observed a dose-dependent activation of platelets and a reduction of platelet ACE2. In their research, SARS CoV-2 stimulated the release of coagulation factors V and xiii and inflammatory factors like cytokines. Additional studies showed activation in the mitogen-activated protein kinase (MAPK) pathway within platelets that plays an active role in the function of platelets.
Clinical RelevanceWhen plasma coagulation occurs, the production of soluble fibrin occurs. A rise in D-Dimer levels indicates an increase in coagulation and the fibrinolysis process. Low levels of D-Dimer are typically utilized to prevent venous embolism (VTE) like deep vein thrombosis of the leg (DVT) and pulmonary embolism (PE).
Diagnostic Value of D-Dimer
- The D-dimer test can be utilized to rule out the possibility of PE or DVT when the levels are below a specific cut-off.
- Since no reference method or material is available, clinical studies are required to establish an assay-specific cut-off and calibrator.
- Numerous studies support the usage of the cut-off, which is 0.5 FEU/LU.
- Suppose the D-dimer levels are higher than the cut-off level. In that case, imaging methods such as sonography and phlebography are essential for determining the cause of VTE.
- The specificity of DVT is variable and populations dependent.
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