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Is D'Dimer Following The Footsteps of Troponin Blood Test?
O P Kapoor
 
Initially when blood levels of troponin T and I were found to be raised in patients suffering from myocardial infarct, the clinicians (specially family physicians) were very happy to get help from a blood test (rather than a cardiologist only), to diagnose a cardiac emergency. What followed is that the importance of troponin levels is now in the textbooks! But troponin levels got so much importance that the terminologies of `unstable angina' and `myocardial infarction" were changed. “Acute Coronary Syndrome” was the new label given to all patients having chest pain with any ECG changes and increased Troponin levels.

As time passed it was realised that there are more than a dozen conditions where Troponin levels can rise including serious hospital patients and even those having Pulmonary Embolism!! At present, the value of this test is that at the end of 12 hours, if the troponin levels are normal, acute coronary syndrome can be excluded by a family physician. So the value of a negative test has become more important.

The history of D'Dimer seems to be repeating like that of Troponin. Initially, we were happy that we have found a blood test to diagnose Pulmonary Embolism. Then followed a number of reports that D'Dimer blood levels were also elevated in deep vein thrombosis, DIC, renal, liver and cardiac failure, major injuries and surgeries, etc.

Srinivas et al on page 290 of this issue report elevated levels in patients of prostatic cancer, before and even after the operation. This seems to be the first report in world literature. If similar reports continue to pour in, the family physicians will be left with only one lesson to learn - that a negative D'Dimer excludes Pulmonary Embolism. However, a positive D-dimer test does not do so. This calls for looking out for many other conditions which can raise D'Dimer levels.