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When Is An Elevated D Dimer A Result Of A

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Posted on Wed, 27 May 2020
Question: When is an elevated d dimer a result of a serious condition? My elevated d dimer is abnormal and I have consistently had abnormal lymphocyte counts. I have had a chronic cough (>10 months) leading to chest pain, abdominal pain, increasing fatigue, nausea, occasional vomiting, shortness of breath, night sweats, itchy legs and feet and SOB since. I have a 4.4x1.5x1 cm liver lesion that turn out to be fatty liver, but by the doctor concern after originally believing it to be a tumor, was a diagnosis of fatty liver. I am 20 years old and have had mono five times as well. Could it be chronic mono based symptoms? Please let me know your thoughts
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Follow up: Dr. Ilir Sharka (0 minute later)
When is an elevated d dimer a result of a serious condition? My elevated d dimer is abnormal and I have consistently had abnormal lymphocyte counts. I have had a chronic cough (>10 months) leading to chest pain, abdominal pain, increasing fatigue, nausea, occasional vomiting, shortness of breath, night sweats, itchy legs and feet and SOB since. I have a 4.4x1.5x1 cm liver lesion that turn out to be fatty liver, but by the doctor concern after originally believing it to be a tumor, was a diagnosis of fatty liver. I am 20 years old and have had mono five times as well. Could it be chronic mono based symptoms? Please let me know your thoughts
doctor
Answered by Dr. Ilir Sharka (19 hours later)
Brief Answer:
I would explain as follows:

Detailed Answer:
Hello!

Welcome on - Ask a Doctor - service!

I passed carefully through your medical history and would like to explain that an elevated d dimer in the settings of your clinical and laboratory findings is a marker of an acute inflammation.

Coming to this point, it is necessary undergoing a careful differential diagnosis:

Chronic mononucleosis should be carefully sought as some of your symptoms (fatigue, night sweats, etc.) in the context of previous infections are highly suggestive. In this regards, I recommend discussing with your doctor on the possibility of checking whether an increased EBV immunoglobulin G (IgG) VCA antibody titers are present. Pancytopenia (decreased blood cells count) and lymphadenopathy are also frequently found. In this case, such a diagnosis would be confirmed.

Anyways, it is necessary to further investigate for alternative health disorders as well. Hematologic tests as well a pulmonary imagine tests (includic lung CT) are required.

Cardiac tests like ECG, cardiac ultrasound and troponin should be performed.

Lyme disease is another alternative diagnosis to be excluded/confirmed.

You should discuss with your doctor on the above mentioned issues.

In case of any further questions, feel free to as me again.

Hope to have been helpful to you!

Kind regards,

Dr. Ilir Sharka
cardiologist
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
doctor
Answered by Dr. Ilir Sharka (0 minute later)
Brief Answer:
I would explain as follows:

Detailed Answer:
Hello!

Welcome on - Ask a Doctor - service!

I passed carefully through your medical history and would like to explain that an elevated d dimer in the settings of your clinical and laboratory findings is a marker of an acute inflammation.

Coming to this point, it is necessary undergoing a careful differential diagnosis:

Chronic mononucleosis should be carefully sought as some of your symptoms (fatigue, night sweats, etc.) in the context of previous infections are highly suggestive. In this regards, I recommend discussing with your doctor on the possibility of checking whether an increased EBV immunoglobulin G (IgG) VCA antibody titers are present. Pancytopenia (decreased blood cells count) and lymphadenopathy are also frequently found. In this case, such a diagnosis would be confirmed.

Anyways, it is necessary to further investigate for alternative health disorders as well. Hematologic tests as well a pulmonary imagine tests (includic lung CT) are required.

Cardiac tests like ECG, cardiac ultrasound and troponin should be performed.

Lyme disease is another alternative diagnosis to be excluded/confirmed.

You should discuss with your doctor on the above mentioned issues.

In case of any further questions, feel free to as me again.

Hope to have been helpful to you!

Kind regards,

Dr. Ilir Sharka
cardiologist
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ilir Sharka (42 minutes later)
I am unsure how to upload documents, but I will upload some numbers.

2/17/20
In my platelet function essay, I was >300 closure sec
Collagen/ADP: 162 closure sec
RBC: 4.0 m/Ul
Neutrophil %: 29.4
Lymph%: 57.1
Mono %: 12.1
ANC: 1.3
EGFR: 115
AST: 56
LYM #: 3.9

2/17
Lymph%: 63

Previous Lymph % after multiple oncology, internal MD, and gastroenterology specialists ordered blood tests have shown a number in the 60's for lymph% since over seven months ago.

Cardiologist ordered a tilt table for POTS, which I was borderline positive for. I noticed when I began feeling sick my heart rate and blood pressure jumped. I had CT of the chest which showed thymic tissue and small liver fatty infiltrate. Upper GI scope (or CT scan, whichever would produce these results) showed mild basilar scarring. None of the issues concerned the doctors other than the lymphocytes paired with chronic cough, nausea, abdominal pain, night sweats, etc. I've never felt so chronically sick in 20 yrs of life. But mostly, I am more curious as to what the results mean since medical tests are foreign to me. Thank you for your help!
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Follow up: Dr. Ilir Sharka (0 minute later)
I am unsure how to upload documents, but I will upload some numbers.

2/17/20
In my platelet function essay, I was >300 closure sec
Collagen/ADP: 162 closure sec
RBC: 4.0 m/Ul
Neutrophil %: 29.4
Lymph%: 57.1
Mono %: 12.1
ANC: 1.3
EGFR: 115
AST: 56
LYM #: 3.9

2/17
Lymph%: 63

Previous Lymph % after multiple oncology, internal MD, and gastroenterology specialists ordered blood tests have shown a number in the 60's for lymph% since over seven months ago.

Cardiologist ordered a tilt table for POTS, which I was borderline positive for. I noticed when I began feeling sick my heart rate and blood pressure jumped. I had CT of the chest which showed thymic tissue and small liver fatty infiltrate. Upper GI scope (or CT scan, whichever would produce these results) showed mild basilar scarring. None of the issues concerned the doctors other than the lymphocytes paired with chronic cough, nausea, abdominal pain, night sweats, etc. I've never felt so chronically sick in 20 yrs of life. But mostly, I am more curious as to what the results mean since medical tests are foreign to me. Thank you for your help!
doctor
Answered by Dr. Ilir Sharka (1 hour later)
Brief Answer:
I would explain as follows:

Detailed Answer:
Hello again!

Thank you for the additional information!

Let me explain your blood lab tests:

The platelet function assay is a screening test for platelet dysfunction. It includes Collagen/ADP which normal range is 58-123 seconds. Prolongation of this test, as in your case indicates a platelet dysfunction (leading to an increased risk of bleeding), which could be related to anemia, low platelet count or another disorder. Once anemia and low platelet count have been excluded, further evaluation to exclude von Willebrand disease and inherited/acquired platelet dysfunction such as renal failure storage pool disease, release defect, Bernard-Soulier disease, and Glanzmann thromboasthenia should be considered. Long-term aspirin therapy may modestly prolong the Col/AD.

The lymphocytes (lymph%) are above the normal ranges while the monocytes (mono%)are borderline. The normal ranges for lymphocytes is 26-46%, while the normal range for monocytes is 8-12%. The increased lymphocytes percent may indicate a viral infection like mononucleosis or even Tuberculosis or Lyme disease. Lym#3.9 is the absolute number of lymphocytes. So, it is evaluated similar to lymph%.

ANC stands for absolute neutrophil count and its normal range is 1.5-8. In your case it is borderline low, which indicates a low neutrophil count (other type of white blood cells), typical of viral infections (including Tuberculosis and Lyme).

The EGFR evaluates your kidney function and it is within the normal ranges.

The AST is a liver enzyme, which evaluates the liver function. Its normal range is 10-40, so it is a little high (I would say borderline). This could be related to the fatty liver.

Hope you will find this information helpful!

I remain at your disposal for any further questions whenever you need!

Kind regards,

Dr. Iliri
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
doctor
Answered by Dr. Ilir Sharka (0 minute later)
Brief Answer:
I would explain as follows:

Detailed Answer:
Hello again!

Thank you for the additional information!

Let me explain your blood lab tests:

The platelet function assay is a screening test for platelet dysfunction. It includes Collagen/ADP which normal range is 58-123 seconds. Prolongation of this test, as in your case indicates a platelet dysfunction (leading to an increased risk of bleeding), which could be related to anemia, low platelet count or another disorder. Once anemia and low platelet count have been excluded, further evaluation to exclude von Willebrand disease and inherited/acquired platelet dysfunction such as renal failure storage pool disease, release defect, Bernard-Soulier disease, and Glanzmann thromboasthenia should be considered. Long-term aspirin therapy may modestly prolong the Col/AD.

The lymphocytes (lymph%) are above the normal ranges while the monocytes (mono%)are borderline. The normal ranges for lymphocytes is 26-46%, while the normal range for monocytes is 8-12%. The increased lymphocytes percent may indicate a viral infection like mononucleosis or even Tuberculosis or Lyme disease. Lym#3.9 is the absolute number of lymphocytes. So, it is evaluated similar to lymph%.

ANC stands for absolute neutrophil count and its normal range is 1.5-8. In your case it is borderline low, which indicates a low neutrophil count (other type of white blood cells), typical of viral infections (including Tuberculosis and Lyme).

The EGFR evaluates your kidney function and it is within the normal ranges.

The AST is a liver enzyme, which evaluates the liver function. Its normal range is 10-40, so it is a little high (I would say borderline). This could be related to the fatty liver.

Hope you will find this information helpful!

I remain at your disposal for any further questions whenever you need!

Kind regards,

Dr. Iliri
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ilir Sharka (2 hours later)
To clarify, the elevated d-dimer and platelet counts are an indication of bleeding? From the MD’s I have seen I felt as if they portrayed the opposite- risk of clotting. I appreciate your help, however! It’s interesting for sure. Thank you!!
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Follow up: Dr. Ilir Sharka (0 minute later)
To clarify, the elevated d-dimer and platelet counts are an indication of bleeding? From the MD’s I have seen I felt as if they portrayed the opposite- risk of clotting. I appreciate your help, however! It’s interesting for sure. Thank you!!
doctor
Answered by Dr. Ilir Sharka (14 hours later)
Brief Answer:
I would explain as follows:

Detailed Answer:
Hello again!

I am sorry, but this is a little complicated.

D dimmer is a protein derived by the degradation of blood clots.It is increasing in blood clotting.

While platelet function assay ( which is different from the platelet count) is the time that platelets need to aggregate ( attach to each other) and form the blood clot. If an increased time, means that the platelet function is not good, which means that they do not form the blood clot very fast and thus increase the risk of bleeding.

Anyway, there are special conditions that increase the two elements of platelet function assay, and the results should be analyzed by a specialist . The platelet dysfunction could be related to the increased d dimmer levels , as part of the same process ( inflammation or infection). These elements are not concerning for increased blood clotting, but are the consequence of an infection or inflammation.

For this reason, the main thing to do is to find the cause of the infection or inflammation.

Hope you will find this information helpful!

Kind regards,

Dr.Iliri
Above answer was peer-reviewed by : Dr. Prasad
doctor
doctor
Answered by Dr. Ilir Sharka (0 minute later)
Brief Answer:
I would explain as follows:

Detailed Answer:
Hello again!

I am sorry, but this is a little complicated.

D dimmer is a protein derived by the degradation of blood clots.It is increasing in blood clotting.

While platelet function assay ( which is different from the platelet count) is the time that platelets need to aggregate ( attach to each other) and form the blood clot. If an increased time, means that the platelet function is not good, which means that they do not form the blood clot very fast and thus increase the risk of bleeding.

Anyway, there are special conditions that increase the two elements of platelet function assay, and the results should be analyzed by a specialist . The platelet dysfunction could be related to the increased d dimmer levels , as part of the same process ( inflammation or infection). These elements are not concerning for increased blood clotting, but are the consequence of an infection or inflammation.

For this reason, the main thing to do is to find the cause of the infection or inflammation.

Hope you will find this information helpful!

Kind regards,

Dr.Iliri
Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. Ilir Sharka (14 hours later)
Okay
So I have had an infection for ten months? Cough for ten months? How can that be accurate?
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Follow up: Dr. Ilir Sharka (0 minute later)
Okay
So I have had an infection for ten months? Cough for ten months? How can that be accurate?
doctor
Answered by Dr. Ilir Sharka (8 hours later)
Brief Answer:
My opinion as follows:

Detailed Answer:
Hello again!

Yes, it could be a chronic infection. It is well known in medical practice that some infections can become chronic lasting even for years.

For this reason, it is important performing some tests to investigate for the possible causes.

I would also recommend performing pulmonary function tests and checking allergy tests in order to exclude an allergic reaction.

You should discuss with your doctor on the above tests.

Wishing all the best,
Dr.Iliri
Above answer was peer-reviewed by : Dr. Yogesh D
doctor
doctor
Answered by Dr. Ilir Sharka (0 minute later)
Brief Answer:
My opinion as follows:

Detailed Answer:
Hello again!

Yes, it could be a chronic infection. It is well known in medical practice that some infections can become chronic lasting even for years.

For this reason, it is important performing some tests to investigate for the possible causes.

I would also recommend performing pulmonary function tests and checking allergy tests in order to exclude an allergic reaction.

You should discuss with your doctor on the above tests.

Wishing all the best,
Dr.Iliri
Above answer was peer-reviewed by : Dr. Yogesh D
doctor
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Follow up: Dr. Ilir Sharka (8 hours later)
Would COPD or a diagnosis infecting my liver and lungs be possible?

Thank you for your help.
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Follow up: Dr. Ilir Sharka (0 minute later)
Would COPD or a diagnosis infecting my liver and lungs be possible?

Thank you for your help.
doctor
Answered by Dr. Ilir Sharka (13 hours later)
Brief Answer:
My opinion as follows:

Detailed Answer:
Hello again!

I don't think that your symptoms are suggestive of COPD. Anyway , pulmonary function tests would help exclude this possibility.

A chronic infection could affect both your liver and lungs, as well as other organs causing these changes in the blood lab tests.

An allergic reaction could mimic this situation too.

For this reason, I would recommend performing further tests ( as above recommended) in order to investigate for the possible cause underlying your clinical situation.

Hope you will find this information helpful!

Wishing all the best,

Dr.Iliri
Above answer was peer-reviewed by : Dr. Yogesh D
doctor
doctor
Answered by Dr. Ilir Sharka (0 minute later)
Brief Answer:
My opinion as follows:

Detailed Answer:
Hello again!

I don't think that your symptoms are suggestive of COPD. Anyway , pulmonary function tests would help exclude this possibility.

A chronic infection could affect both your liver and lungs, as well as other organs causing these changes in the blood lab tests.

An allergic reaction could mimic this situation too.

For this reason, I would recommend performing further tests ( as above recommended) in order to investigate for the possible cause underlying your clinical situation.

Hope you will find this information helpful!

Wishing all the best,

Dr.Iliri
Above answer was peer-reviewed by : Dr. Yogesh D
doctor
default
Follow up: Dr. Ilir Sharka (7 hours later)
What pulmonary function tests would you recommend? Appreciate all the help you have provided.
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Follow up: Dr. Ilir Sharka (0 minute later)
What pulmonary function tests would you recommend? Appreciate all the help you have provided.
doctor
Answered by Dr. Ilir Sharka (18 hours later)
Brief Answer:
I would recommend as follows:

Detailed Answer:
Hello again!

I would recommend performing spirometry, which evaluates the pulmonary function and excludes copd or asthma.

Hope you will find this information helpful!

If you have any other questions, I would be glad to assist you further!

Kind regards,

Dr.Iliri
Above answer was peer-reviewed by : Dr. Prasad
doctor
doctor
Answered by Dr. Ilir Sharka (0 minute later)
Brief Answer:
I would recommend as follows:

Detailed Answer:
Hello again!

I would recommend performing spirometry, which evaluates the pulmonary function and excludes copd or asthma.

Hope you will find this information helpful!

If you have any other questions, I would be glad to assist you further!

Kind regards,

Dr.Iliri
Note: For further queries related to kidney problems Click here.

Above answer was peer-reviewed by : Dr. Prasad
doctor
Answered by
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Dr. Ilir Sharka

Cardiologist

Practicing since :2001

Answered : 9539 Questions

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When Is An Elevated D Dimer A Result Of A

When is an elevated d dimer a result of a serious condition? My elevated d dimer is abnormal and I have consistently had abnormal lymphocyte counts. I have had a chronic cough (>10 months) leading to chest pain, abdominal pain, increasing fatigue, nausea, occasional vomiting, shortness of breath, night sweats, itchy legs and feet and SOB since. I have a 4.4x1.5x1 cm liver lesion that turn out to be fatty liver, but by the doctor concern after originally believing it to be a tumor, was a diagnosis of fatty liver. I am 20 years old and have had mono five times as well. Could it be chronic mono based symptoms? Please let me know your thoughts