Clinical laboratory investigation of a patient with an extremely high D-dimer level: A case report
Clinical laboratory investigation of a patient with an extremely high D-dimer level: A case report
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D-二聚体水平极高患者的临床实验室检查：病例报告
DOI：
10.12998/wjcc.v8.i16.3560
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发表时间：
2020-08-26
影响因子：
1.1
通讯作者：
Sheng, Hui-Ming
中科院分区：
文献类型：
--
作者：
Sun, Han-Xiao;Ge, Hong;Sheng, Hui-Ming
背景D-二聚体是一种可溶的交联型纤维蛋白降解产物，是诊断弥散性血管内凝血和鉴别诊断血栓形成的重要指标。在此，我们报告一个D-二聚体水平异常升高的老年病例。病例摘要一位82岁的女性，被诊断为慢性心力衰竭，使用Sysmex CS-5100系统™的创新D-二聚体，发现D-二聚体水平显著升高，超过合格范围(>；100 mg/L)。然而，没有证据，包括临床症状，血栓栓塞性疾病的放射证据，以及平行的纤维蛋白原降解产品价值，表明该患者有很高的血小板减少风险。为了确认这一差异，进行了一系列的方法，包括样品稀释，通过替代方法重新分析，以及用特异性异嗜性抗体阻断样品处理。经上述方法处理后，D-二聚体明显消失(分别为4.49、9.42、9.06和12.58 mg/L)。这证实了在该病例中存在异嗜性抗体。此外，心力衰竭引起的心输出量减少也可能是高凝状态存在的原因。结论D-二聚体升高与临床不符时应考虑异嗜性抗体的存在，异嗜性抗体干扰时应考虑病毒感染。
BACKGROUND D-dimer, a soluble degradation product of cross-linked fibrin, is commonly used as an important marker for the diagnosis of disseminated intravascular coagulation and differential diagnosis of thrombosis. Herein, we present a geriatric case with an unusually elevated D-dimer level. CASE SUMMARY An 82-year-old woman, admitted to the ward with a diagnosis of chronic heart failure, was noted to have a remarkably elevated D-dimer level, beyond the qualified range (> 100 mg/L), utilizing the Innovating D-dimer for Sysmex CS-5100 System™. However, no evidence, including clinical symptoms, radiographic evidence of thromboembolic disease, and parallel fibrinogen degradation product values, suggested that this patient was at high risk of thrombopenia. To confirm the discrepancy, a series of approaches including sample dilution, re-analysis via alternative methods, and sample treatment with blockage of specific heterophilic antibodies were performed. A remarkable disappearance of the elevated D-dimer values was observed in the samples after they were subjected to these approaches (4.49, 9.42, 9.06, and 12.58 mg/L, respectively). This confirmed the presence of heterophilic antibodies in this case. In addition, a reduction in cardiac output due to the presence of cardiac failure could also be responsible for the existence of a hypercoagulable state in this case. CONCLUSION In conclusion, the presence of heterophilic antibodies should be considered when an elevated D-dimer value is not in conformity with the clinical evidence, and a viral infection should be considered when interference by a heterophilic antibody exists.