Identification of and solution for false D‐dimer results

Zhang, Xianyan; Zhang, Xuexuan; Xu, Jialong; Huang, Tseng-Chieng; Wu, Ying; Yang, Yeru; Zhou, Huanbin; Wu, Yalan

doi:10.1002/jcla.23216

Cited by 7 publications

(7 citation statements)

References 22 publications

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“…Published reports on antibody interference in D-dimer assays are rare. Cases described in the literature showed that interference in D-dimer assays occurs in both men and women of different ages (3-86 years) and with or without underlying diseases that could impact autoantibody status [ [5] , [6] , [7] , [8] ]. Interestingly, all described cases showed interference on latex-enhanced immunoturbidimetric D-dimer assays and occurred with monoclonal antibodies of different manufacturers, different antibody epitopes, and in reagents with different blocking agents [ 7 ].…”

Section: Conclusion and Discussionmentioning

confidence: 99%

Heterophilic antibodies leading to falsely positive D-dimer concentration in an adolescent

Verboogen

Granzen

Hudig

et al. 2023

Research and Practice in Thrombosis and Haemostasis

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Section: Conclusion and Discussionmentioning

confidence: 99%

Heterophilic antibodies leading to falsely positive D-dimer concentration in an adolescent

Verboogen

Granzen

Hudig

et al. 2023

Research and Practice in Thrombosis and Haemostasis

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“…In contrast, D-dimers are produced during plasmin breakdown of cross-linked fibrin generated through activation of coagulation. 27 Thus, a high FDP:D-dimer ratio suggests hyperfibrinolysis. Although some studies have proposed that immediate overactivation of the protein C pathway may also contribute to hyperfibrinolysis in the setting of traumatic shock, evidence for this mechanism is mixed.…”

Section: Fibrinolysis In Traumatic Brain Injurymentioning

confidence: 99%

Fibrinolysis in Traumatic Brain Injury: Diagnosis, Management, and Clinical Considerations

Anderson

Farrell

Rowell

2021

Semin Thromb Hemost

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Posttraumatic coagulopathy involves disruption of both the coagulation and fibrinolytic pathways secondary to tissue damage, hypotension, and inflammatory upregulation. This phenomenon contributes to delayed complications after traumatic brain injury (TBI), including intracranial hemorrhage progression and systemic disseminated intravascular coagulopathy. Development of an early hyperfibrinolytic state may result in uncontrolled bleeding and is associated with increased mortality in patients with TBI. Although fibrinolytic assays are not routinely performed in the assessment of posttraumatic coagulopathy, circulating biomarkers such as D-dimer and fibrin degradation products have demonstrated potential utility in outcome prediction. Unfortunately, the relatively delayed nature of these tests limits their clinical utility. In contrast, viscoelastic tests are able to provide a rapid global assessment of coagulopathy, although their ability to reliably identify disruptions in the fibrinolytic cascade remains unclear. Limited evidence supports the use of hypertonic saline, cryoprecipitate, and plasma to correct fibrinolytic disruption; however, some studies suggest more harm than benefit. Recently, early use of tranexamic acid in patients with TBI and confirmed hyperfibrinolysis has been proposed as a strategy to further improve clinical outcomes. Moving forward, further delineation of TBI phenotypes and the clinical implications of fibrinolysis based on phenotypic variation is needed. In this review, we summarize the clinical aspects of fibrinolysis in TBI, including diagnosis, treatment, and clinical correlates, with identification of targeted areas for future research efforts.

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“…This not specific cross-linking may result in generation of a falsely positive results. The more common cause of such interference was the presence of heterophilic (or human anti mouse) antibodies [8][9][10].…”

Section: Introductionmentioning

confidence: 99%

Interference of Heterophilic Antibody in D-dimer Determination in an Asymptomatic Elderly Woman

Sara,

Elena,

Mara

et al. 2024

IBRR

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Background: D-Dimer is considered a pivotal biomarker in diagnosis of disseminated intravascular coagulation and in differential diagnosis of thrombosis and pulmonary embolism. Case Summary: BL, Caucasian woman, 81 years old, was admitted to hospital, in October 2023, for concussive head trauma after an accidental fall. The patient had a "non-assayable D-Dimer due to excess antigen" utilizing Sysmex Innovance D-dimer using a Sysmex CS 5100 analyser. This abnormal result was firstly observed in March 2022. A second Laboratory confirmed the raised D-dimer concentration. The patient had undergone periodic D-dimer checks which had always confirmed the results and had been treated with a direct FXa inhibitor. Methods: Patient’s samples were tested for D-dimer using different assays and different analysers, moreover sample diluted in phosphate buffer and heterophilic antibodies blocking reagent have been tested. Results: The Sysmex Innovance D-dimer assay gave us, constantly “non-assayable D-dimer due to excess antigen" results; the HemosIL D-dimer HS assay gave us, constantly a raised D-dimer concentration (four to five higher than upper reference values); the Quidel Triage D-dimer gave us, constantly D-dimer normal concentration. Results obtained from dilution curves confirmed the presence of high concentration high avidity heterophilic antibodies. Conclusions: Reports regarding the influence of heterophilic antibodies on the measurement of D‐dimer are quite uncommon in literature however, they constitute a significant potential risk. Interference from heterophile antibodies often has a different impact using different instruments and methods in the measurement of D‐dimer. Using a combination of different assays and analysers, of dilution strategy with heterophilic antibody blockers, and combining laboratory results with clinical examinations and imaging data, we were able to identify the interference and exclude the presence of thrombosis.

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Identification of and solution for false D‐dimer results

Cited by 7 publications

References 22 publications

Heterophilic antibodies leading to falsely positive D-dimer concentration in an adolescent

Heterophilic antibodies leading to falsely positive D-dimer concentration in an adolescent

Fibrinolysis in Traumatic Brain Injury: Diagnosis, Management, and Clinical Considerations

Interference of Heterophilic Antibody in D-dimer Determination in an Asymptomatic Elderly Woman

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