D-dimer

D-dimer is one of the protein fragments produced when a blood clot gets dissolved
in the body. It is normally undetectable or detectable at a very low level unless the
body is forming and breaking down blood clots. Then, its level in the blood can
significantly rise. This test detects D-dimer in the blood.

When a blood vessel or tissue is injured and begins to bleed, a process

called hemostasis is initiated by the body to create a blood clot to limit and
eventually stop the bleeding. This process produces threads of a protein called
fibrin, which crosslink together to form a fibrin net. That net, together with
platelets, helps hold the forming blood clot in place at the site of the injury until it
heals.

The prothrombin time, sometimes referred to as (PT) or (pro time test) is a test to
evaluate blood clotting.

Prothrombin is a protein produced by your liver. It is one of many factors in the

blood that help it to clot appropriately.

Prothrombin time test results can be presented in two ways.

1. In seconds: -

The average time range for blood to clot is about 10 to 13 seconds. A number
higher than that range means it takes blood longer than usual to clot. A number
lower than that range means blood clots more quickly than normal.

1. As INR: -
This ratio is used if take blood-thinning medications.

 In healthy people, an INR of 1.1 or below is considered normal. An INR range

of 2.0 to 3.0 is generally an effective therapeutic range for people taking
warfarin for disorders such as atrial fibrillation or a blood clot in the leg or lung.
In certain situations, such as having a mechanical heart valve, might need a
slightly higher INR.

 When the INR is higher than the recommended range, it means that the blood
clots more slowly than desired, and a lower INR means the blood clots more
quickly than desired.

 Clotting too slowly

Blood that clots too slowly can be caused by:

1. Blood-thinning medications.

2. Liver problems.

3. Inadequate levels of proteins that cause blood to clot.

4. Vitamin K deficiency.

5. Other substances in the blood that hinder the work of clotting factors

 Clotting too fast

Blood that clots too quickly can be caused by:

1. Supplements that contain vitamin K.

2. High intake of foods that contain vitamin K, such as liver, broccoli, chickpeas,
green tea, kale, turnip greens and products that contain soybeans.

3. Estrogen-containing medications, such as birth control pills and hormone

replacement therapy.

Once the area has had time to heal and the clot is no longer needed, the body uses
an enzyme called plasmin to break the clot (thrombus) into small pieces so that it
can be removed. The fragments of the disintegrating fibrin in the clot are called
fibrin degradation products (FDP), which consist of variously sized pieces of
crosslinked fibrin. One of the final fibrin degradation products produced is D-
dimer, which can be measured in a blood sample when present. The level of D-
dimer in the blood can significantly rise when there is significant formation and
breakdown of fibrin clots in the body.
Mechanism of D-dimer production
A D-dimer test is most often used to find out whether is there a blood clotting
disorder. These disorders include:

1. Deep vein thrombosis (DVT): - a blood clot that's deep inside a vein. These
clots usually affect the lower legs, but they can also happen in other parts of
the body.

2. Pulmonary embolism (PE): - a blockage in an artery in the lungs. It usually

happens when a blood clot in another part of the body breaks loose and
travels to the lungs. DVT clots are a common cause of PE.

3. Disseminated intravascular coagulation (DIC): - a condition that causes

too many blood clots to form. They can form throughout the body, causing
organ damage and other serious complications.

4. Stroke: - a blockage in the blood supply to the brain.

Causes of D-dimer elevation

Reference: -
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5. Mayo Clinic Family Health Book, 5th Edition.