Baseline observations – sats 89% room air, HR 126, BP 111/65, RR33, temp 36.5
Chest x-ray – NAD
D-dimer – 775 ( normal range 208-318 ng/ml)
Hb 67 g/L
Retics – 4%
eGFR 70 ml/min
Urinalysis 1+ protein
You manage to find out a little more about the background of the sickle cell disease:
Recent hospital admission for acute chest crisis, approximately 3 weeks ago. 2 further admissions for painful crisis in past year.
Medications: Hydroxycarbamide, penicillin, folic acid
Baseline Hb 7g/L
Proteinuria noted on last annual review and mild decline in eGFR, however planned for continued monitoring currently.
Vaccinations up to date
Echo performed 6 months ago had no significant findings
Noted to have red cell antibodies
You have commenced treatment for acute chest syndrome, but you want to rule out PE. Does the elevated d-dimer help you in this diagnosis?
What are her risk factors for VTE?
How would you investigate further?