D-di mer le vel in cre a ses when co a gu la ti on system is ac ti va ted. It has be en ac cep ted as a use ful test for the di ag no sis of throm bo em bo lic events for a long ti me. Ho we ver; sin ce Ddi mer may in cre a se in ca ses such as any kind of sur gi cal in ter ven ti on, tra u -ma, tis su e da ma ge, in fec ti ons, preg nancy, dis se mi na ted in tra vas cu lar co a gu la ti on, it cre a tes li mi ta ti ons to its di ag nos tic va lu e.6-8 The re is not suf fi ci ent study in li te ra tu re se arc hing how Ddi mer le vel is af fec ted, when ope ra ti on va ri ety is ta -ken in to con si de ra ti on. In a study by Co di ne et al which in ves ti ga ted the con tri bu ti on of pos to pe ra -ti ve D-di mer me a su re ment to the di ag no sis of
veno us throm bo em bo lism in pa ti ents to whom ort -ho pe dic sur gery was app li ed, D-di mer le vels we re cons tantly ele va ted pos to pe ra ti vely (2 to 6 fold abo ve nor mal). Alt ho ugh D-di mer le vels ha ve re-tur ned to nor mal le vels in 4 we eks, in so me ca ses re ma i ned ele va ted (3-fold abo ve nor mal). D-di mer TABLE 2: D-dimer levels of operation groups having more than four cases.
SD: Standard deviation.
Operation
indications Patients
n Preoperative
D-dimer(mg/L) Postoperative D-dimer (ng/mL)
Mean± SD Min-max 1st day Mean ± SD Min-max
3stday Mean ± SD Min-max
7stday Mean ± SD Min-max
15stday Mean ± SD Min-max Inguinal hernia 10 0.109 ± 0.126 0.017-0.378 0.228 ± 0.227 0.044-0.637 0.224 ± 0.267 0.038-0.395 0.271 ± 0.441 24-1.506 0.285 ± 0.501 0.036-1.636 Incisional hernia 5 0.240 ± 0.235 0.044-0.642 0.558 ± 0.491 0.185-1.382 0.163 ± 0.033 0.122-0.204 0.333 ± 0.173 0.118-0.520 0.297 ± 0.126 0.126-0.469 Multi-nodular goiter 13 0.255 ± 0.457 0.025-1.422 0.270 ± 0.210 0.036-0.581 0.126 ± 0.105 0.032-0.423 0.123 ± 0.107 0.036-0.382 0.110 ± 0.151 0.017-0.567 Pilonidal sinus 6 0.130 ± 0.109 0.035-0.283 0.160 ± 0.152 0.003-0.360 0.151 ± 0.069 0.048-0.239 0.074 ± 0.048 0.032-0.138 0.121 ± 0.080 0.034-0.237 Cholelithiasis 12 0.154 ± 0.228 0.014-831 0.412 ± 0.501 0.014-1.382 0.479 ± 0.376 0.230-1.561 0.365 ± 0.301 0.048-0.908 0.240 ± 0.269 0.020-0.879 Total 46 0.179 ± 0.285 0.014-1.422 0.315 ± 0.349 0.003-1.382 0.247 ± 0.270 0.032-1.561 0.235 ± 0.283 0.024-1.506 0.204 ± 0.287 0.017-1.636
Days mean ± SD (mg/L) min-max (mg/L)
Preoperative day 0.186 ± 0.344 0.003-1.908
Postoperative 1stday 0.312 ± 0.346 0.003-1.382 Postoperative 3rdday 0.307 ± 0.410 0.032-2.277 Postoperative 7thday 0.289 ± 0.443 0.024-2.764 Postoperative 15thday 0.271 ± 0.528 0.003-3.170
TABLE 3: D-dimer levels of 59 patients.
FI GU RE 2: Chan ges in pos to pe ra ti ve D-di mer re la ted to age.
PRO: pre o pe ra ti ve, PO 1: pos to pe ra ti ve first day, PO 3: pos to pe ra ti ve third day, PO 7:
pos to pe ra ti ve se venth day, PO 15: pos to pe ra ti ve fif te enth day.
le vel was not sig ni fi cantly dif fe rent bet we en pa ti mg/L, 1.229 mg/L, 2.091 mg/L res pec ti vely). Em-bo lism was not de tec ted in this pa ti ent. in both gro ups af ter ope ra ti on, but they didn’t find the re sults sta tis ti cally me a ning ful.13Mar ti nezRa cho lecy sti tis. Ho we ver; sin ce long ti me-con su ming ma jor ope ra ti on such as co lon can cer and gas tric
TABLE 4: P values of D-dimer levels on postoperative days, compared with preoperative values.
0.186±0.344 <0.001*
0.186±0.344 <0.001*
0.186±0.344 <0.013
0.186±0.344 <0.140
*According to Bonferroni correction, only these values were assumed as significant.
con si de red. Post me no pa u se pha se may al so af fect signs. They sug ges ted that the se two op ti mum cu toff va lu es are use ful for de ter mi ning the ne ed for furt her throm bo sis proph yla xis with LMWH was ad jus ted ac cor ding to le vels of D-di mer. They we re di vi ded in to a high-risk gro up and a mo de ra te-risk gro up.
A high-risk gro up sho wed sig ni fi cantly hig her Ddi mer le vels than a mo de ra te – risk gro up. Me a su throm bo sis or pul mo nary em bo lism in the early pos to pe ra ti ve pe ri od. Ho we ver, in or der to be ab
Acckk nnooww lleeddgg mmeennttss
The aut hors thank Er dem KA RA BU LUT for sta tis ti cal n-a ge ment study. Am J Med 2004;116: 352-3.
3. Ging sbery JS, Wells PS, BrillEd wards P, Do no van D, Pan ju A, van Be ek EJ, et al. App li ve no us throm bo em bo lism. Chest 2003;124:
1116-9. -ting post-tra u ma tic se ri al chan ges for D-di mer and PA I-1 in cri ti cally in ju red pa ti ents. Thromb pa ti ents. J Tra u ma 2001;51:425-30.
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emir eksikliği (DEA) dünyada anemi nedenleri arasında en sık gö-rülenidir.1Ülkemiz gibi gelişmekte olan ülkelerde yaygın bir halk sağlığı sorunudur. Kronik demir eksikliği anemisinde eritrosit ya-şam süresi uzamakta, kronik bir hipoksi söz konusu olmakta, demir eksik-liği nedeni ile yeterince hemoglobin (Hb) sentez edilememektedir. Bu