Semin Thromb Hemost 2022; 48(06): 672-679
DOI: 10.1055/s-0042-1748193
Review Article

D-dimers—“Normal” Levels versus Elevated Levels Due to a Range of Conditions, Including “D-dimeritis,” Inflammation, Thromboembolism, Disseminated Intravascular Coagulation, and COVID-19

1   Department of Haematology, Manchester University Hospitals, Manchester, United Kingdom
2   Department of Haematology, Institute of Clinical Pathology and Medical Research (ICPMR), NSW Health Pathology, Westmead Hospital, Westmead, New South Wales, Australia
3   Sydney Centres for Thrombosis and Haemostasis, Westmead, New South Wales, Australia
4   Faculty of Science and Health, Charles Sturt University, Wagga Wagga, New South Wales, Australia
5   Section of Clinical Biochemistry, University Hospital of Verona, Verona, Italy
› Author Affiliations


D-dimers reflect a breakdown product of fibrin. The current narrative review outlines how D-dimers can arise in normal individuals, as well as in patients suffering from a wide range of disease states. D-dimers in normal individuals without evident thrombosis can arise from background fibrinolytic activity in various tissues, including kidney, mammary and salivary glands, which ensures smooth flow of arising fluids where any blood contamination could be immediately lysed. In addition, healthy individuals can also regularly sustain minor injuries, often unbeknown to them, and wound healing follows clot formation in these situations. D-dimers can also arise in anxiety and following exercise, and are also markers of inflammation. Lung inflammation (triggered by microbes or foreign particles) is perhaps also particularly relevant, since the hemostasis system and fibrinolysis help to trap and remove such debris. Lung inflammation in patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may contribute to D-dimer levels additive to thrombosis in patients with COVID-19 (coronavirus disease 2019). Indeed, severe COVID-19 can lead to multiple activation events, including inflammation, primary and secondary hemostasis, and fibrinolysis, all of which may contribute to cumulative D-dimer development. Finally, D-dimer testing has also found a role in the diagnosis and triaging of the so-called (COVID-19) vaccine-induced thrombotic thrombocytopenia.


The opinions expressed in this review are those of the authors and do not necessarily reflect those of our respective employers: Manchester University Hospitals, NSW Health Pathology, and University of Verona.

Publication History

Article published online:
08 July 2022

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