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Medical Forum / General / Laboratory / September 2003FDP/DDI
Any reason for having both tests in a coag department? DDI are FDP specifically from fibrin degradation, so I really question need for both. We have orders for one or the other but never both. I want to talk to our medical staff about dropping the FDP, but would like some input as to how the rest of the world handles this testing.  SignatureAll the burning bridges that have fallen after me All the lonely feelings and the burning memories Everyone I left behind each time I closed the door Burning bridges lost forevermore For Big Joe, Crap Game, Odd Ball and Kelley > Any reason for having both tests in a coag department? DDI are FDP > specifically from fibrin degradation, so I really question need for both. > We have orders for one or the other but never both. I want to talk to our > medical staff about dropping the FDP, but would like some input as to how > the rest of the world handles this testing. AFAIK most of the people in my neck of the woods (South East UK) have abandoned FDP in favour of D - dimers. Hope that helps MB And if anyone can automate D-dimers onto a Sysmex CA 7000, I'd be eternally grateful > Any reason for having both tests in a coag department? DDI are FDP > specifically from fibrin degradation, so I really question need for both. > We have orders for one or the other but never both. I want to talk to our > medical staff about dropping the FDP, but would like some input as to how > the rest of the world handles this testing. They are not identical tests and each is evaluated separately in terms of clinical conditions. The problem lies in ROC characteristics in evaluating DIC especially chronic DIC states. The negative predictive value if both tests are used approaches 99% versus less so for only doing DD. It's the old specificity vs. sensitivity argument where DD is more specific but FSP more sensitive. The presence of schistocytes is far less sensitive, I don't have the numbers right now, but with TTP it approaches 99%. There is no one specific and sensitive test for DIC which is why all these tests are being performed so as not to miss something. We have had recently a doctor demanding a one to one mix of PTT stat in order to rule out DIC and he didn't even order a quantitative DDQ. I for one would not mind getting rid of the FSP. Unfortunately before we did the automated DDQ when ever a doctor would order an FSP only we would add on a DD when the FSP tested positive. If they ordered a DD only then that would be the only test that we would perform. > Any reason for having both tests in a coag department? DDI are FDP > specifically from fibrin degradation, so I really question need for both. OK, I got the numbers now although the studies seem to be old and don't really know if they still apply. Sensitivity Specificity FDP 95% 56 D Dimer 85-93 97 FDP+D Dimer 100 97 FDP provides proof of plamin effect D Dimer proof thrombin + plasmin effect FDP + D Dimer confirms DIC Sem Throm Hemost 1988:14:299 AMJ Clin Path 1989:91 :280 Arch Intern Med 149:1724 Saved & printed It probably still has relevance. Thanks SignatureAll the burning bridges that have fallen after me All the lonely feelings and the burning memories Everyone I left behind each time I closed the door Burning bridges lost forevermore For Big Joe, Crap Game, Odd Ball and Kelley > > > Any reason for having both tests in a coag department? DDI are FDP [quoted text clipped - 17 lines] > AMJ Clin Path 1989:91 :280 > Arch Intern Med 149:1724 |
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