PE and D-dimer?

Question

I am a Critical Care RN and at work had an episode of sudden onset tachycardia, facial flushing (I felt like I was having a hot flash), and tachypnea (rr was 30-40's) this lasted for several hours and I was seen in the ER where I work. My CT was negative for any overt PE but my D-dimer was 5.0 (5000) I have Leventhal-Stein (also known as PCOS). I was treated within the last two weeks for an apparent URI (cough, wheeze, sob, fever, clogged sinuses) I had gall bladder surgery 4 months ago (laparascopic removal but d-dimer usually returns to normal within 3 months even for CABG). They ran a thyroid panel to see if I was having issues there (no results yet), but will thyroid or hormonal issues elevate a d-dimer to that extent? I take glucophage every day (1000 mg)(but its not a medication known to artificially elevate the d-dimer). I see pts every day with many other issues with only slightly elivated d-dimers. I am personally at a loss and are concerned that much of the respiratory symptoms that I had may have been PE rather than URI. Any thoughts? Also How long will PE's show up for on CT?

I know infections can elivate a d-dimer but my WBC was 5.4

I am not on any type of hormone therapy and in No distress. Was not feeling in any distress when I went to the ER and of course as a cardiac nurse (ICU Cardiac) could not even comprehend that this could be happening to me...

And no VQ scan was done. will probably be sent for one on tuesday when i follow up with my MD. of course I have done so much research on this i am still at a loss

Also am aware that overt cancer, kidney failure and liver failure can cause elivated d-dimer as can IBS, Chrons (sp sorry), and a host of other disorders all which have been ruled out...

Answer 1

Well, you should know that MRIs and CTs do not see anything less that 4mm. And with the positive d-dimer they should be looking for a clot.

So are you taking hormones for the PCOS? Those can cause unprovoked clotting usually caused by an underlying clotting disorder that was undectective to start off with. I would have them test you for Antiphospholipid Antibody Syndrome as I have seen several patients with both APS and PCOS.

If you are still in distress, you need to go back to the ER. Did they do a VQ scan?

ETA: Why are you waiting until Tuesday to get a VQ scan? You are a nurse - your doctor could have ordered that without seeing you but since you are no long in distress, I can see why you would want to wait. I have APS, MTHFR & Lp(a) and a positive d-dimer with those symptoms above would have had me admitted to the hospital to find the clot.

Answer 2

Hard to know why your d-dimer was elevated. According to what I just read, the D-dimer test is only about 50% specific for a clot. Can be elevated with inflammation, heart disease, liver disease, infection, or recent surgery to name a few. If you had a PE, I would have suspected that it would show up on CT (hopefully they did a spiral CT scan.) The PE will show up on CT for as long as the clot is present in your body. The only other suggestion I would have is to have doppler U/S done of your extremities to rule out a clot there.

http://www.labtestsonline.org/understanding/analytes/d_dimer/test.html
http://www.answers.com/topic/d-dimer

Answer 3

Usually as soon as they do the CT, they do a PE protocol.

Answer 4

WHAT???????????????????