D-Dimer Ölçümü ve Klinik Kullanımı
Özet
D-dimer, trombin, aktive faktör XIII ve plazmin enzimlerinin kademeli etkisiyle meydana gelen çapraz bağlı fibrin pıhtılarının spesifik bir bozunma ürünüdür. Monoklonal antikorlar tarafından spesifik epitopların hedeflenmesiyle gerçekleştirilen D-dimer ölçümünde ELISA (altın standart), ELFA, lateks bazlı immünotürbidimetrik yöntemler, CLIA ve hasta başı (POC) tam kan testleri gibi çeşitli teknikler kullanılmaktadır. Yöntemler arasında evrensel bir kalibratör bulunmaması nedeniyle standardizasyon eksikliği mevcut olup, sertifikalı kantitatif immünokimyasal testlerin seçilmesi ve 50 yaş ve üzerindeki bireylerde yaşa göre ayarlanmış eşik değerlerin (yaş x 10 µg/L FEU) uygulanması önerilmektedir. D-dimer seviyeleri enfeksiyon, travma, cerrahi, gebelik, yaşlılık ve kanser gibi trombotik olmayan birçok klinik durumda da yükselebildiği için tromboz tanısında düşük özgüllüğe sahiptir. Buna karşın, yüksek negatif öngörü değeri (NPV) sayesinde pre-test klinik olasılık değerlendirmeleriyle birlikte kullanıldığında özellikle venöz tromboembolizm (VTE), derin ven trombozu (DVT) ve pulmoner emboli (PE) hastalıklarının dışlanmasında son derece güvenilirdir. Ayrıca dissemine intravasküler koagülasyon (DİK) tanı ve takibinde ISTH skorlamasında yer almasının yanı sıra iskemik kalp hastalıkları, aort diseksiyonu ve COVID-19 infeksiyonlarında anormal pıhtılaşma ve kötü prognozun bir göstergesi olarak klinik önem sunmaktadır.
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