Clinical laboratory investigation of a patient with an extremely high D-dimer level:A case report  

作　　者：Han-Xiao Sun Hong Ge Zhong-Qing Xu Hui-Ming Sheng 

机构地区：[1]Department of Laboratory Medicine,Tongren Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200336,China [2]Department of General Practice,Tongren Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200336,China

出　　处：《World Journal of Clinical Cases》2020年第16期3560-3566,共7页世界临床病例杂志

基　　金：Supported by the National Natural Science Foundation of China,No.81672083 and No.81702071

摘　　要：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.

关 键 词：D-DIMER Heterophilic antibodies Epstein-Barr virus Case report 

分 类 号：R446.1[医药卫生—诊断学]