※ 引述《abrring (abrring)》之銘言：
: 35 下列何種情況血中D-dimer濃度不會異常升高？
: (A) Hemarthrosis (B) Five days after major operation
: (C) Brain sinus thrombosis (D)Inferior vena cava thrombosis
: 答案: A
: 建議答案: A 和 B
: 根據Harrison 17th Edition p365:
: D-Dimer assays can be used as sensitive markers of blood clot formation, and
: some have been validated for clinical use to exclude the diagnosis of deep
: venous thrombosis (DVT) and pulmonary embolism in selected populations.
: D-Dimer在臨床上用來排除及偵測肺栓塞和Deep Vein Thrombosis.
: 選項(B) Five days after major operation，如果D-dimer升高，且臨床症狀亦符合，
: 可以懷疑肺栓塞，但並非”所有” 手術的病人D-dimer一定會升高。顧建議答案(A) 和
: (B) 皆可。
我補充一下
根據sabiston 18th ed
In the postoperative patient, D-dimer is causally elevated due to surgery,
and, as such, a positive D-dimer assay for evaluating for DVT is of no use.
However, a negative D-dimer test in patients with suspected DVT has a high
negative predictive value, ranging from 97% to 99%
可見術後d-dimer可能會因為手術升高, 如果只是因為d-dimer(+)而懷疑DVT而做評估
是沒有用的(意思應該要從S&S著手, 不要只是看數據)
但後兩行也代表d-dimer也有可能在手術後並不會升高, 這樣就可以幾乎排除DVT
因此手術後五天d-dimer也有可能不會升高, 故建議答案為 A或B
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