My D-dimer is raised from 1.5 to 5.9 and all tests are normal. What could be the reason?

Question

Hello doctor,

My D-dimer is getting higher from 1.5 to 5.9 within the last four months. My heart has been checked, and I had a chest X-ray, CT of heart, aorta, abdomen, and pelvic floor and Doppler of my legs. All are clear. Blood work is normal apart from D-Dimer and c-reactive protein which is 12.6 mg/L. What can it be?

Answer 1

Hello,

Welcome to icliniq.com.

Following is my opinion about your asked question.

D-dimer is usually elevated in some thrombotic events in the body like DIC (disseminated intravascular coagulation), deep vein thrombosis or pulmonary embolism. But your CT chest and Doppler leg are normal as per history. So pulmonary embolism and DVT can be excluded.

The other causes for elevated D-dimer can be liver disease, heart disease, inflammation, post-surgery, and pregnancy as well. Your heart is normal as per history, so heart disease can be excluded. You can rule out the liver disease by SGPT (serum glutamic pyruvic transaminase), SGOT (serum glutamic-oxaloacetic transaminase), and serum protein estimation.

If you have pregnancy or surgery history than it can be the cause.

PT (prothrombin time), PTT (partial thromboplastin time) and coagulation profile can be planned by your doctor if D- dimer remains persistently high. Kindly attach your report to give further comments if possible.

Answer 2

Hello,

Welcome back to icliniq.com.

I have read your attached reports. (attached removed to protect patient identity).

CT angiography of chest and Doppler scan of the leg are normal. So, we can exclude pulmonary embolism and DVT as a cause for elevated D-dimer. Your ANA, ANCA are also normal, so autoimmune diseases seem less likely.

Now, you can investigate further with echocardiography to rule out the cardiac cause and SGPT, SGOT to rule out any liver inflammation if present. PT and aPTT also can be done to check for the function of coagulation factors. You can plan endoscopy as well to rule out inflammation of the intestine.

Your scan shows pleural thickening with calcified granuloma, so it might be the cause if the lesion is active. For that take advice from a pulmonologist. Your all workup for PE and DVT are normal, so inflammation in the body might be the cause for elevated D-dimer.

Kindly consult a nearby hematologist for physical examination and discuss further investigation plans as explained. If still all comes clear and pleural thickening is non-specific then no further management is needed. Discuss all these with your hematologist.