title: Sensitive and quantitative, 10-min immunofluorometric assay for D-Dimer in whole blood.
abstract: BACKGROUND
  Normal concentrations of D-Dimer can be used to exclude venous thromboembolism (VTE). However, methods for sensitive and quantitative D-Dimer measurements at the point-of-care (POC) are still limited.
  
  
  METHODS
  We developed a 10-min, non-competitive immunofluorometric assay for D-Dimer in citrated whole blood and plasma using pre-dispensed reagents dried in single assay wells. The simple, automated assay procedure comprises a 1:50 sample dilution, one-step incubation, washing, and time-resolved fluorometric measurement directly from the wet well surface.
  
  
  RESULTS
  The limits of detection (background + 3SD) and quantification (CV <15%) were 0.05 and 0.2 mg/L D-Dimer, respectively, and the assay was linear up to 400 mg/L. Correlations to Roche TinaQuant (r=0.726, n=200) and Biopool Auto.Dimer (r=0.190, n=149) were carried out using citrated plasma. Diagnostic sensitivity, specificity, and negative (NPV) and positive (PPV) predictive values were 98.7%, 64.4%, 99.1% and 55.1%, and 92.2%, 81.0%, 95.9% and 68.3%, respectively, using cut-off values of 0.6 and 1.0 mg/L, respectively, in outpatients with deep vein thrombosis (DVT) and/or pulmonary embolism (PE) (n=77) compared with outpatients with various other diseases (n=174). The within- and between-run CVs near the cut-off values were < or =10% in both whole blood and plasma. The 95th percentile upper range in apparently healthy individuals was 0.68 mg/L of whole blood (n=101).
  
  
  CONCLUSIONS
  The high sensitivity and NPV suggest that the rapid immunofluorometric assay could be valuable for rapid exclusion of VTE in outpatients. With appropriate cut-offs, the assay could potentially be used as a stand-alone test or combined with clinical probability assessment, but further studies are required.
authors.affiliation: Department of Biotechnology, University of Turku, Turku, Finland. piia.vonlode@utu.fi
authors.forename: Piia
authors.initials: P
authors.lastname: von Lode
authors.forename: Jarmo
authors.initials: J
authors.lastname: Rainaho
authors.forename: Mia K
authors.initials: MK
authors.lastname: Laiho
authors.forename: Kari
authors.initials: K
authors.lastname: Punnonen
authors.forename: Olli
authors.initials: O
authors.lastname: Peltola
authors.forename: Veli-Pekka
authors.initials: VP
authors.lastname: Harjola
authors.forename: Kim
authors.initials: K
authors.lastname: Pettersson
mesh_terms: D000911:Antibodies, Monoclonal; D001774:Blood Chemical Analysis / Q000379:methods*; D001780:Blood Coagulation Tests / Q000379:methods*; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis* / Q000276:immunology; D015200:Fluoroimmunoassay / Q000379:methods*; D006801:Humans; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
chemical_list: D000911:Antibodies, Monoclonal; D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D