elevated D Dimer tests in pregnancy

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I am a 29 year-old woman in my first pregnancy, currently almost 16 weeks along. During my thirteenth week I had a D Dimer test following some pain and swelling in my arm. It was slightly elevated at .67 (they told me .5 and below is the normal range). Yesterday I had another D Dimer test done following chest pain and trouble breathing. The result was 1.35 (again with .5 being considered normal). I had a clear chest X-Ray and CT as well as a clear ultrasound of my legs. The ER doctor explained that D Dimer levels commonly fluctuate during pregnancy and there was no evidence of PE or DVT, at least in my legs. Are my pregnancy values "normal" or do I need to be concerned that there has been a rapid elevation in the level over a period of approximately three weeks? Does this warrant further monitoring, in case there is some clotting problem elsewhere in my body?

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Dr. B,

I just found out that I have a borderline high anticardiolipin antibody (IgG). Does this coupled with my elevating D Dimer level warrant concern, further testing, or possibly treatment?

[Elaine Brown, MD]

Hi!
The doctor in the emergency room is correct that d dimer is unreliable during pregnancy.
I try not to order that test if possible, because the results are often very confusing.
If you have a negative CT scan, there is very little possibility that you have a pulmonary embolus.  If you do/did have clots elsewhere, I would expect some symptoms such as swelling, etc.  There would be very little harm in doing doppler studies of your legs to rule out clots there however.

Swelling and shortness of breath are normal during pregnancy, so it can be very tricky to know which symtoms are pregnancy related and which are signs of pathology ( clots).

If you were my patient, I would probably reassure you that unless you have an heriditary clotting disorder, you can probably relax.  Naturally we always remain alert for the possibility of blood clots though, and we should evaluate any new symptoms.

Good luck!
Dr B