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Bloodwork Showing Higher and Higher Clot Breakdown (D-Dimer)

  • Thread starter Deleted member 106824
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D

Deleted member 106824

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Not sure if too many here will be familiar here with the blood value D-Dimer but it is a measure of clot breakdown. So if one's D-Dimer is elevated that means there are clots being formed and broken down in their body. Generally measured to assess risk of pulmonary embolism.

Mine was once elevated (greater than 500) at 570 on 1/30/15 but a CT scan showed no pulmonary embolism. After that it was normal at 340 on 9/19/16. Then elevated to 630 on 8/30/17. Then elevated to 1110 on 12/6/17. Then elevated to 1370 on 1/12/18. Now elevated to 1750.

I know this is not a common thing talked about here but I'm wondering if anyone has any experience with this or insight I might be missing. I am on 80mg TRT per week (4x20mg) and 1mg of adex per week (2x0.5mg). I started the Adex on 8/1/2017 so that's one thing that sticks out but otherwise I have no explanation. I do cardio for 2+hr per week total. VO2 max is ~50. No symptoms during exertion. Occasional chest pressure which has been there for years on and off and my cardiologists don't seem to see as an issue.

I have talked to my cardiologists about this when it was 1110 and their response was basically "we don't have guidelines for this other than to check for pulmonary embolism". Basically they don't know what to do with the value but there is no way it going up so significantly month after month is normal. All other bloodwork is great. CRP 0.2. RBC/Hb/Hct are actually a bit below normal range. All of my clotting factors are normal. But D-dimer is now far above normal.


Stewie, GotGame and other docs or experienced members, any idea here?
 

Stewie

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Not sure if too many here will be familiar here with the blood value D-Dimer but it is a measure of clot breakdown. So if one's D-Dimer is elevated that means there are clots being formed and broken down in their body. Generally measured to assess risk of pulmonary embolism.

Mine was once elevated (greater than 500) at 570 on 1/30/15 but a CT scan showed no pulmonary embolism. After that it was normal at 340 on 9/19/16. Then elevated to 630 on 8/30/17. Then elevated to 1110 on 12/6/17. Then elevated to 1370 on 1/12/18. Now elevated to 1750.

I know this is not a common thing talked about here but I'm wondering if anyone has any experience with this or insight I might be missing. I am on 80mg TRT per week (4x20mg) and 1mg of adex per week (2x0.5mg). I started the Adex on 8/1/2017 so that's one thing that sticks out but otherwise I have no explanation. I do cardio for 2+hr per week total. VO2 max is ~50. No symptoms during exertion. Occasional chest pressure which has been there for years on and off and my cardiologists don't seem to see as an issue.

I have talked to my cardiologists about this when it was 1110 and their response was basically "we don't have guidelines for this other than to check for pulmonary embolism". Basically they don't know what to do with the value but there is no way it going up so significantly month after month is normal. All other bloodwork is great. CRP 0.2. RBC/Hb/Hct are actually a bit below normal range. All of my clotting factors are normal. But D-dimer is now far above normal.


Stewie, GotGame and other docs or experienced members, any idea here?

I would suspect it's related to your autoimmune disease (Crohn's).

As you're probably aware, D-dimer is what's consider an acute phase reactant. Amongst other things, it's triggered by various cell-mediated immunological
and inflammatory responses.

I'm surprised your cardiologist didn't correlate the two.

I'd track your flair ups in relationship to your labs to see if there's a correlation.
 
D

Deleted member 106824

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I would suspect it's related to your autoimmune disease (Crohn's).

As you're probably aware, D-dimer is what's consider an acute phase reactant. Amongst other things, it's triggered by various cell-mediated immunological
and inflammatory responses.

I'm surprised your cardiologist didn't correlate the two.

I'd track your flair ups in relationship to your labs to see if there's a correlation.

I was on the phone with the cardiologist fellow at Cleveland Clinic months ago and it wasn't until I brought up my Crohn's that he said "oh you know I forgot about that, that could be why it's elevated". Unfortunately even at a top cardiac hospital it seems they were not looking at the entire picture. That was the fellow though and not the main doc.

So after the conversation I figured ok it's probably from the Crohn's. But now I'm thinking it's not. Here are my D-Dimer values

1/30/16- 570 (80mg TRT. Minimal GI issues)
9/19/16- 340 (80mg TRT. In a flare)
8/30/17- 630 (80mg TRT + 2mg adex just started on 8/1/17. Mild GI issues)
12/16/17 - 1110 (80mg TRT + 1mg adex. Minimal GI issues.)
1/12/18- 1370 (80mg TRT + 1mg adex. Minimal GI issues)
2/15/18- 1750 (80mg TRT + 1mg adex. No minimal issues)

I was in a significant flare around the 9/19/16 testing and my D-Dimer was normal. Now I'm in remission....things are going quite well with my GI issues (feels almost non-existent) and yet my D-Dimer continues to go higher and higher. My CRP is only 0.2 and my ESR is 6.

Supplementation is potent fish oil, curcumin and ginger extract (quite a bit...50ml of the extract) all of which supposedly have "blood thinning" anticoagulant properties.


The only correlation I see at all is potentially the adex. I began using adex this summer (8/1/17) and every measurement since then has shown a higher D-Dimer. Does that make any sense to you? Frankly I don't see why they would correlate at all but it's the only correlation I can see.
 

bieberhole69

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I would suspect it's related to your autoimmune disease (Crohn's).

As you're probably aware, D-dimer is what's consider an acute phase reactant. Amongst other things, it's triggered by various cell-mediated immunological
and inflammatory responses.

I'm surprised your cardiologist didn't correlate the two.

I'd track your flair ups in relationship to your labs to see if there's a correlation.

This...

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5609977/

(one of several studies)

But you know...higher lipid values are correlated with increased d-dimer. Adex is known to cause lipid issues in most. How does your lipid panel look now compared to pre-adex?
 
D

Deleted member 106824

Guest
This...

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5609977/

(one of several studies)

But you know...higher lipid values are correlated with increased d-dimer. Adex is known to cause lipid issues in most. How does your lipid panel look now compared to pre-adex?

Thanks for posting. I'm familiar with the paper and it is how I justified d-dimer being elevated previously but if you check out my post above I really do not see a correlation with my crohn's at all. I don't want to get too graphic but I was getting blood and diarrhea in the toilet when I had that normal D-dimer of 340 whereas now I have dramatically elevated D-Dimer and very normal trips to the bathroom.

I was not aware lipid values and D-Dimer were correlated.

I HAVE noticed a worsening of lipids on adex for sure.

Here are pre-adex levels

Cholesterol, Total: 184 (125-200 mg/dL)
HDL Cholesterol: 77 (> 40 mg/dL)
LDL Cholesterol: 97 (<130 mg/dL)
Triglycerides: 48 (<150 mg/dL)


Here they were on 2mg adex per week
Cholesterol, Total: 167 (125-200 mg/dL)
HDL Cholesterol: 54 (> 40 mg/dL)
LDL Cholesterol: 98 (<130 mg/dL)
Triglycerides: 64 (<150 mg/dL)


As you can see it tanked HDL

Here it is on 1mg adex per week

Cholesterol, Total: 225 (125-200 mg/dL)
HDL Cholesterol: 71 (> 40 mg/dL)
LDL Cholesterol: 139 (<130 mg/dL)
Triglycerides: 59 (<150 mg/dL)

Dropping to 1mg seemed to allow HDL to get back up but now LDL is quite high


Here is another on 1mg adex


Cholesterol, Total: 181 (125-200 mg/dL)
HDL Cholesterol: 67 (> 40 mg/dL)
LDL Cholesterol: 100 (<130 mg/dL)
Triglycerides: 57 (<150 mg/dL)



And finally my recent levels on 1mg adex:

Cholesterol, Total: 205 (125-200 mg/dL)
HDL Cholesterol: 62 (> 40 mg/dL)
LDL Cholesterol: 129 (<130 mg/dL)
Triglycerides: 45 (<150 mg/dL)


As you can see, on the whole my lipids are worse on adex, either with a lower HDL or a higher LDL. All of these tests are between 8/2017 to 2/2018. The second to last values here were similar to when I was off adex but if we look at the total picture it seems a significant negative effect.

I have considered coming off the adex due to this, but now have an even bigger reason to if it's causing the elevated d-dimer as well. I just hadn't seen any evidence for that.
 
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D

Deleted member 106824

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What were the values of the clotting factors?


Here is everything. Insulin and T3 below normal due to finishing up a pretty severe diet.

Factor X Activity: 94 (70-150% normal)
Factor V Mutation (Leiden): Not Detected
Fibrinogen Activity, Clauss: 292 (175-425 mg/dL)
Von Willebrand Ag: 63 (50-217%)
Magnesium: 2.0 (1.5-2.5mg/dL)
D Dimer: 1.76 (<0.50 mcg/mL)
BNP: 28 (<100 pg/ml)
DHT: 63 (16-79 ng/dL)
Estradiol: 34 (< 39 pg/mL)
IGF-1, LC/MS: 163 (63-373 ng/mL)
Z Score (Male): -0.2 (-2.0-+2.0 SD)
Insulin: 1.0 (2-19.6 uIU/mL)
Cortisol, A.M.: 15.3 (4.0-22.0 mcg/dL)
Glucose: 74 (65-99 mg/dL)
Urea Nitrogen (BUN): 26 (7-25 mg/dL)
Creatinine: 1.24 (0.6-1.35 mg/dL)
BUN/Creatinine Ratio: 21 (6-22 calc)
eGFR Non-Afr Am.: 80 (> or = 60 mL/min/1.73m2)
eGFR Afr Am.: 92 (> or = 60 mL/min/1.73m2)
Sodium: 139 (135-146 mmol/L)
Potassium: 4.1 (3.5-5.3 mmol/L)
Chloride: 105 (98-110 mmol/L)
Carbon Dioxide: 24 (20-31 mmol/L)
Calcium: 9.2 (8.9-10.4 mg/dL)
GGT: 7 (3-7 U/L)
Protein, Total: 6.4 (6.3-8.2 g/dL)
Albumin: 4.1 (3.6-5.1 g/dL)
Globulin: 2.3 (2.1-3.5 g/dL)
Albumin/Globulin Ratio: 1.8 (1.0-2.1)
Bilirubin, Total: 0.9 (0.2-1.1 mg/dL)
Alkaline Phosphatase: 57 (48-230 U/L)
AST: 24 (12-32 U/L)
ALT: 46 (8-46 U/L)
TSH: 2.13 (0.4-4.5 mIU/L)
T4, Free: 1.0 (0.8-1.8 ng/dL)
T3, Free: 2.0 (2.3-4.2 pg/mL)
Cholesterol, Total: 205 (125-200 mg/dL)
HDL Cholesterol: 62 (> 40 mg/dL)
Cholesterol/HDL: 3.3 (< 5.0)
LDL Cholesterol: 129 (<130 mg/dL)
Triglycerides: 45 (<150 mg/dL)
Non-HDL Cholesterol: 143 (30 mg/dL more than LDL)
hs-CRP: 0.2 (<1 mg/L = low risk. 1-3 = avg risk. 3-10 = high risk)
ESR, Westergren: 6 (0-15 MM/HR)
WBC Count: 3.9 (3.8-10.8 Thousand/uL)
RBC Count: 3.94 (4.2-5.8 Million/uL)
Hemoglobin: 13.2 (13.2-17.1 g/dL)
Hematocrit: 38.2 (38.5-50.0%)
 

MKSuccess500

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Your ESR is normal, which correlates with Fibrinogen generally speaking. Your CRP is low too. If all of those are low as are your other clotting factors then I would think that means you're not forming significant clots. Someone feel free to correct me if that logic isn't correct.

Your CBC values are also borderline anemic. I would think this also makes you less likely to form a clot but again someone correct me if I'm wrong.

Hopefully that is good news but I'm sorry to say I have no idea why your dimer levels are elevated either
 
D

Deleted member 106824

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Thanks, I'm not sure either.

Like I said the only correlation I see is that I started arimidex in August and since then it's gotten higher every single time.

Having said that, high estrogen is known to increase clotting...so I don't see why bringing it down with arimidex would be the cause of d-dimer going up.
 

Stewie

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Then there's the associations of iron deficiency and thrombosis. I've mentioned this in the past.

Aside from the known platelet aggregates of both iron deficiency and Crohn's. My question would arise, have you taking any types of stims, such as ephedrine or done any HIIT type of cardio durning the subsequent rise in your D-dimer?

Throwing thoughts out there.
 

emeric delczeg

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Thanks, I'm not sure either.

Like I said the only correlation I see is that I started arimidex in August and since then it's gotten higher every single time.

Having said that, high estrogen is known to increase clotting...so I don't see why bringing it down with arimidex would be the cause of d-dimer going up.

Do you have your Crohn's under control?
 
D

Deleted member 106824

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Do you have your Crohn's under control?

My Crohn's symptoms come and go but for the most part it has been well controlled recently. Minimal gas/cramping/blood. Controlled with diet and mesalamine (i.e. no more advanced drugs required at this point).
 
D

Deleted member 106824

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Then there's the associations of iron deficiency and thrombosis. I've mentioned this in the past.

Aside from the known platelet aggregates of both iron deficiency and Crohn's. My question would arise, have you taking any types of stims, such as ephedrine or done any HIIT type of cardio durning the subsequent rise in your D-dimer?

Throwing thoughts out there.

In the past my Iron and Ferritin levels low or low-normal, while Hb/Hct/RBC values were similarly low to what they are now or as high as mid-range, but it's been years since I've had Iron and Ferritin tested.

My last test was January 2016
Iron, Total: 67 (45-175mcg/dL)
Iron Binding Capacity: 341 (250-425 mcg/dL)
% Saturation: 20 (20-50%)
Ferritin: 34 (20-345 ng/mL)

For what it's worth, looking at my Fitday values I tend to be eating 15-50mg (200-600% RDA) of iron per day.

As you may recall though, this has been the case for me as long as I've been tested. So it would seem this is not the cause of the large increase in D-Dimer in the last 6 months or so. What do you think? Regardless, I should probably test Iron and Ferritin again. Unfortunately good diet and supplementation previously seemed ineffective to improve this.




Due to my heart concerns I never take significant amounts of stimulants. At most I will get ~50-100mg of caffeine from black tea and the small amounts remaining in decaf tea/coffee a few times per week.

I perform 120min of cardio per week, which has included 1-2 (generally 1) session of HIIT within the week which is just 10x15sec sprints on a bike. That has been constant for over a year now....what are you thinking here?
 
D

Deleted member 106824

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I know this is a lot but just FYI Stewie for your reference regarding what you mentioned, these are all the values I have related to Iron/Ferritin. Also looking back at my data I was taking an Iron+Vitamin C supplement every day up until 1-2 weeks before the 2014 test....which showed my highest total iron, iron binding capacity, and % Saturation (though still low ferritin)...not sure why I stopped it, maybe I should get back on that. Though again this is nothing new and seems to be separate from the D-Dimer sudden increase since August



11/8/2010
RBC Count: 3.65 (4.2-5.8 Million/uL)
Hemoglobin: 12.5 (13.2-17.1 g/dL)
Hematocrit: 36.0 (38.5-50.0%)

RDW: 12.6 (11-15%)
Platelet Count: 134 (140-400 Thousand/uL)
Ferritin: 91 (10-105 ng/mL)


3/3/2012
RBC Count: 4.16 (4.2-5.8 Million/uL)
Hemoglobin: 13.1 (13.2-17.1 g/dL)

Hematocrit: 39.7 (38.5-50.0%)
RDW: 15.4 (11-15%)
Platelet Count: 139 (140-400 Thousand/uL)

Iron, Total: 54 (45-175mcg/dL)
Iron Binding Capacity: 325 (250-425 mcg/dL)
% Saturation: 17 (20-50%)
Ferritin: 40 (20-345 ng/mL)

11/26/13
RBC Count: 4.78 (4.20-5.80 Million/uL)
Hemoglobin: 13.9 (13.2-17.1 g/dL)
Hematocrit: 43.5 (38.5-50.0%)
RDW: 14.5 (11.0-15.0%)
Platelet Count: 185 (140-400 Thousand/uL)
Ferritin: 8 (20-345ng/mL)


3/13/14
RBC Count: 4.82 (4.20-5.80 Million/uL)
Hemoglobin: 14.1 (13.2-17.1 g/dL)
Hematocrit: 43.2 (38.5-50.0%)
RDW: 17.5 (11.0-15.0%)
Platelet Count: 160 (140-400 Thousand/)
Iron: 122 (45-175mcg/dL)
Iron Binding Capacity: 409 (250-425 mcg/dL)
% Saturation: 30 (20-50%)
Ferritin: 13 (20-345ng/mL)


1/9/17
RBC Count: 4.76 (4.2-5.8 Million/uL)
Hemoglobin: 14.8 (13.2-17.1 g/dL)
Hematocrit: 46.0 (38.5-50.0%)
RDW: 14.5 (11-15%)
Platelet Count: 152 (140-400 Thousand/uL)
Iron, Total: 73 (45-175mcg/dL)
Iron Binding Capacity: 351 (250-425 mcg/dL)
% Saturation: 21 (20-50%)
Ferritin: 34 (20-345 ng/mL)
 

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