Dr. Sagar Ramesh Makode
Cardiology
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hello doctor,
I got blood work for recurrent chest pain. All was normal, but my D-dimer was 1.28 ug/ml (normal below 0.50). Chest CT with contrast normal, doppler u/s both legs normal, abdomen/pelvic CT, as well as abdominal ultrasound normal. The doctor says not to worry about D-dimer, but it was normal range a year ago. I had a hysterectomy, endometriosis excision, or fallopian tubes removed five months ago and it resulted in an abscess and sepsis. I was hospitalized for a week but recovered. I have Hashimoto's but no treatment because my TSH is in a normal range. Should I continue to pursue the D-dimer? Currently, I am taking Lexapro 10 mg daily.
Hello,
Welcome to icliniq.com.
I think we should retest D-dimer maybe after a few weeks, three to four weeks. This is to see the trend and confirm the elevated levels. The usual causes for elevation include DVT (deep vein thrombosis), pulmonary embolism, infection, stroke, trauma, and rarely some cancerous conditions. Also, D-dimer rises with age. But, all your investigations are negative so ruling out the major and important causes for elevated D-dimer.
I guess at this moment, you are totally asymptomatic, right? No fever or any evidence of infection, etc. The elevation from the previous infection five months back should have settled by this time. You have undergone all possible tests to rule out the causes of elevated D-dimer, so I think there is no need to worry about it at this moment. So overall, I think we should repeat the test after three to four weeks. Also, see if you have any symptoms, or let me know if you suffered from a recent infection or trauma.
Patient's Query
Hi doctor,
Thank you for the reply.
My first reading was 1.18, then the second one after four days (different lab) was 1.28. I waited 12 days and had another one drawn, and it was 1.98. These are on a scale of 0.50, being the limit. Nothing is showing up on my other tests, as you can see above. I am at a loss, as is my doctor. Do you have any recommendations?
Hello,
Welcome back to icliniq.com.
So it is elevated without any cause. The next thing which can do is a PET scan. I think it is better to go ahead with a whole-body PET scan to rule out occult cancer or infection. A PET scan will show if any serious abnormalities are going anywhere in the body. So you discuss the PET scan with your local doctor.
Patient's Query
Hello doctor,
Thank you for the reply.
I made an error in my last post, my latest reading was not 1.98 it was 1.12. So basically, it has been 1.18, four days later 1.28, and then 12 days later 1.12. So it has gone down a tiny bit. Would you recommend, at this point, I wait maybe a few weeks and test again to see if it goes down, or would you proceed with a PET scan? Thank you very much for all of your insight, you have been a huge help to me.
Hi,
Welcome back to icliniq.com.
Still, there is no significant fall, and the level is well above the reference range without evident cause. So I think it is worthwhile to get it done. My major concern is malignancy, and once we have ruled it out sure, then we will have additional assurance. So I think let's proceed with it. All the best.
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