Case 58- update 2

Our patient has a possible DVT. She has a painful, swollen left leg with some mild erythema. The Wells’ score is 1 and therefore a d-dimer test is required. Had the score been 2 it would be reasonable to move to an ultrasound doppler scan of the lower limb.  If the patient was pregnant the Wells’ score and d-dimer wouldn’t apply as it is not validated in pregnancy and often the d-dimer is elevated in the pregnant state. Ther astute GP has done a pregnancy test and it is negative.

 

She is referred to an ambulatory care centre where a d-dimer is requested and it is positive; therefore she needs an ultrasound scan of the lower limb.

 

Questions:

  • What are the other causes of raised d-dimer?
  • Would you do an ultrasound of the whole leg or limited to the thigh?
  • If an ultrasound scan is not available today what would you do?

 

Please reply to us (@TeamHaem) on Twitter and always include #TeamHaem to allow others to follow your comments. Please join in the debate and learn about haematological problems along the way. The case will continue to  evolve over the coming week so keep checking #TeamHaem on Twitter for more information.

Please note – all cases on TeamHaem are entirely fictional to protect patient confidentiality.

TeamHaem are not a position of authority.  It is an educational platform to allow discussion and learning.

 

About TeamHaem

Online education and discussion about all things haematological
This entry was posted in Anticoagulation, Thrombosis and tagged , , , , , , . Bookmark the permalink.