Madhumitah Ravi

I17014008
Assignment 1
D-dimer is also known as a cross-linked fibrin degradation product. The presence of D-dimer is
discovered to be a result of blood coagulation and disintegration of clot which can be estimated
by the examination of a blood test. It consists of the remnants of all three chains (α, β and γ
chains) of fibrinogen cross-linked by disulfide bonds. The dimeric formation of D-dimer is held
with the aid of covalent, intermolecular isopeptide bonds among the γ-chains. The structure of D-
dimer is either a 180 kDa or 195 kDa molecule of 2 D domains or a 340 kDa molecule of 2 D
domain names and 1 E scope of the initial fibrinogen molecule. ( Adam SS.2009) A four-fold
expansion in the protein is a solid indicator of mortality in those affected by COVID-19.(Zhou,
F.) D-dimer is released when a blood clot begins to break down. When a blood capillary is
injured and begins to exude blood, a sequence of clotting and factors is activated. During this
process, fibrin is produced and they are held together by thrombin to form a net to stop the bleed.
This process called coagulation, proceeds to form a clot. Once healed, plasmin is produced to
break the clot into smaller pieces. When this fibrin mesh work or clot is dissolved it produces
two types of components. Few of the compounds which have different length of fibers are called
as fibrin degradation products(FDP) and another protein fragment is called as d-dimer.This d-
dimer protein is normally cleared within short period of time so under normal conditions the
significant d dimer levels are not found in blood since d-dimer is only going to be formed after
the dissolution of the blood clot. However, under abnormal conditions such as difficulty in
breathing, chest pain or swelling, persistent cough etc. Hence,a d-dimer test is going to be
prescribed when few of the mentioned symptoms is observed in patients. Covid-19 has a distinct
coagulopathy and it is marked by mild thrombocytopenia and elevation of prothrombin time,
elevated fibrinogen, and highly elevated D-dimers, leading to increased risk of thrombosis but
overt disseminated intravascular coagulopathy (DIC). (N Tang,2020) A recent study made in an
ICU in France indicates that a significant difference of venous thromboembolism(VTE) rate in
Covid-19 patients present there compared to the other non-Covid ICU patience. There is also
autopsy evidence of microthrombosis on patients with Covid-19.(D.Wichmann,2020)
Inflammation and thrombosis go hand in hand as they are linked together by the endothelial cells
which have both anti-thrombotic and anti-inflammatory properties. So when the endothelium is
disrupted it loses its anti-thrombotic and anti-inflammatory properties meaning both the
thrombotic and the inflammatory systems are activated which leads to damage from both the
inflammation and thrombosis. ( Jackson SP,2019). Researchers hypothesized that while the virus
can cause serious lung disease, the virus called SARS-CoV-2 can also trigger clotting which
leads to Infection or damage to the inner lining of the blood vessel. However, there are some
limitations to to the D-dimer test. D-dimer testing has limited clinical utility because of its poor
specificity. This is particularly true for older patients, those who have undergone prolonged
hospitalization, patients with chronic VTE, pregnant women, and those with increasingly
elevated C-reactive protein levels. In some patient subsets, a negative non-ELISA D-dimer test
cannot discriminate between inpatients with and without coronary thrombosis or pulmonary
embolism.(Rodger MA, 2014)

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 Madhumitah Ravi
I17014008

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