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%

HbS 40%

eGFR 70 ml/min

Urinalysis 1+ protein

You manage to find out a little more about the background of the sickle cell disease:

HbSS

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?