Guest guest Posted August 31, 2012 Report Share Posted August 31, 2012 An elevated D-dimer is not a lab result you chase. Many things can elevate it. It’s value is that if it is normal, the probability of a DVT or PE is very, very low. If it’s elevated it tells you nothing. Anemia and dehydration don’t feel good. I am assuming her O2 sats are normal. There is no evidence of pulmonary disease. I would suggest iron and hydration. And repeat CBC in a few weeks. Kathy Saradarian, MDNJ From: [mailto: ] On Behalf Of Dannielle HarwoodSent: Thursday, August 30, 2012 9:54 PMTo: Subject: Elevated d-dimer My case of the week.....50y/o Caucasian female donates blood then later that day while with her daughter at a burger joint (she was NOT eating there she assured me) she felt lightheaded and nauseous and laid her head down on a table and lost consciousness. Event witness. Was told she was out for 2-5 min. Did drive self and duaghter home but later went to ER. EKG and CXR nml.CMP with sodium of 133 and BUN of 26.Hgb of 10elevated d-dimer.Was given a lab slip for an outside lab and told to follow up with PCP. Repeat labs showed nml sodium and BUN and a hgb of 10.3....d-dimer not available for several days.Patient complaining of feeling exhausted but not light headed also is short of breath vs easily winded if walking. Sent of CT angiogram. No PE.D-dimer eventually comes back....now nml???Saw patient on Wed.....exactly one week post. Still feels very tired although better.Repeat labs (3rd lab involved as I do not trust the 2nd lab she went to)...shows nml CMP. Hgb 10. 6 and elevated d-dimer.Apparently has a h/o borderline anemia...cannot always give blood. Has elevated chol. Mild overweight. Still menstruating.Thoughts???coronary vs malignancy work up?Love the collective brain!Dannielle Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 31, 2012 Report Share Posted August 31, 2012 Do you have a baseline hgb/hct?Need to rule out the obvious, a GI malignancy….. Definitely would recommend a colonoscopy…to start… From: [mailto: ] On Behalf Of Dannielle HarwoodSent: Thursday, August 30, 2012 6:54 PMTo: Subject: Elevated d-dimer My case of the week.....50y/o Caucasian female donates blood then later that day while with her daughter at a burger joint (she was NOT eating there she assured me) she felt lightheaded and nauseous and laid her head down on a table and lost consciousness. Event witness. Was told she was out for 2-5 min. Did drive self and duaghter home but later went to ER. EKG and CXR nml.CMP with sodium of 133 and BUN of 26.Hgb of 10elevated d-dimer.Was given a lab slip for an outside lab and told to follow up with PCP. Repeat labs showed nml sodium and BUN and a hgb of 10.3....d-dimer not available for several days.Patient complaining of feeling exhausted but not light headed also is short of breath vs easily winded if walking. Sent of CT angiogram. No PE.D-dimer eventually comes back....now nml???Saw patient on Wed.....exactly one week post. Still feels very tired although better.Repeat labs (3rd lab involved as I do not trust the 2nd lab she went to)...shows nml CMP. Hgb 10. 6 and elevated d-dimer.Apparently has a h/o borderline anemia...cannot always give blood. Has elevated chol. Mild overweight. Still menstruating.Thoughts???coronary vs malignancy work up?Love the collective brain!Dannielle Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 31, 2012 Report Share Posted August 31, 2012 She's mildly anemic, gives blood and then faints later on that day.I'd stop her giving blood.You didn't mention her BP whether she has a postural drop or not. Do you have a baseline hgb/hct?Need to rule out the obvious, a GI malignancy….. Definitely would recommend a colonoscopy…to start… From: [mailto: ] On Behalf Of Dannielle Harwood Sent: Thursday, August 30, 2012 6:54 PMTo: Subject: Elevated d-dimer My case of the week.....50y/o Caucasian female donates blood then later that day while with her daughter at a burger joint (she was NOT eating there she assured me) she felt lightheaded and nauseous and laid her head down on a table and lost consciousness. Event witness. Was told she was out for 2-5 min. Did drive self and duaghter home but later went to ER. EKG and CXR nml.CMP with sodium of 133 and BUN of 26.Hgb of 10elevated d-dimer.Was given a lab slip for an outside lab and told to follow up with PCP. Repeat labs showed nml sodium and BUN and a hgb of 10.3....d-dimer not available for several days. Patient complaining of feeling exhausted but not light headed also is short of breath vs easily winded if walking. Sent of CT angiogram. No PE.D-dimer eventually comes back....now nml???Saw patient on Wed.....exactly one week post. Still feels very tired although better. Repeat labs (3rd lab involved as I do not trust the 2nd lab she went to)...shows nml CMP. Hgb 10. 6 and elevated d-dimer.Apparently has a h/o borderline anemia...cannot always give blood. Has elevated chol. Mild overweight. Still menstruating. Thoughts???coronary vs malignancy work up?Love the collective brain!Dannielle -- Graham Chiuhttp://www.compkarori.co.nz:8090/Synapse - the use from anywhere EMR. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 31, 2012 Report Share Posted August 31, 2012 She’s mildly anemic because she is a menstruating female who just donated a unit of blood. Then tried to have a normally active day. No mention of if she hydrated herself. It’s a significant amount of blood to lose in one day! Check her iron stores. If low, check menstrual history to see if she is heavy and not telling anyone. If normal, then you don’t really need to worry about chronic losses. Have her take iron, recheck her h/h in 2 weeks to make sure she has replaced her losses and be done with it. She does not need a million dollar workup given the setting. If she has syncope again without any obvious causes or becomes anemic again without any obvious causes, then worry. But the d-dimer is not an issue that you work-up. It’s a potential marker only. Kathy Saradarian, MD From: [mailto: ] On Behalf Of H. KimSent: Friday, August 31, 2012 12:08 AMTo: Subject: RE: Elevated d-dimer Do you have a baseline hgb/hct?Need to rule out the obvious, a GI malignancy….. Definitely would recommend a colonoscopy…to start… From: [mailto: ] On Behalf Of Dannielle HarwoodSent: Thursday, August 30, 2012 6:54 PMTo: Subject: Elevated d-dimer My case of the week.....50y/o Caucasian female donates blood then later that day while with her daughter at a burger joint (she was NOT eating there she assured me) she felt lightheaded and nauseous and laid her head down on a table and lost consciousness. Event witness. Was told she was out for 2-5 min. Did drive self and duaghter home but later went to ER. EKG and CXR nml.CMP with sodium of 133 and BUN of 26.Hgb of 10elevated d-dimer.Was given a lab slip for an outside lab and told to follow up with PCP. Repeat labs showed nml sodium and BUN and a hgb of 10.3....d-dimer not available for several days.Patient complaining of feeling exhausted but not light headed also is short of breath vs easily winded if walking. Sent of CT angiogram. No PE.D-dimer eventually comes back....now nml???Saw patient on Wed.....exactly one week post. Still feels very tired although better.Repeat labs (3rd lab involved as I do not trust the 2nd lab she went to)...shows nml CMP. Hgb 10. 6 and elevated d-dimer.Apparently has a h/o borderline anemia...cannot always give blood. Has elevated chol. Mild overweight. Still menstruating.Thoughts???coronary vs malignancy work up?Love the collective brain!Dannielle Quote Link to comment Share on other sites More sharing options...
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