D-Dimer Assay during Menstrual Period.

Introduction:

Fibrin D-dimer is the degradation products from cross-linked fibrin. It is a marker of intravascular thrombogenesis. Menstruation is associated with activation of coagulation and fibrinolytic pathways. To investigate the changes of plasma fibrin D-dimer level during menstruation cycle, we measure the D-dimer level on day 1, 3, 5, and 21 of the menstruation period for 5 consecutive female volunteers. MDA D-dimer assay is used because it is one of the most sensitive laboratory methods for quantitative measurement of D-dimer level.

Methods:

Normal female volunteers with normal regular menstruation cycle are recruited. To avoid other confronting factors, subjects with recent history of thromboembolic diseases; ischemic heart disease; pregnancy or child birth; active malignancy; active inflammatory or infectious disease; surgery or trauma; and/or use of birth control pills are excluded. All volunteers have the menstruating period identified. Day 1 of menstruating period is defined as the first day when menstruating flow occurs. On Day 1, 3, 5 and 21 of menstruating cycle, blood samples are collected in tubes precoated with 3.2% trisodium citrate-dihydrate. Specimens are centrifuged at 2500 g for 15 minutes. The MDA D-dimer assay is performed using a commercial kit as per manufacturer’s instructions. Plasma fibrin MDA D-dimer level is expressed in F.E.U./ml (normal range is <0.50 F.E.U./ml). ANOVA statistical analysis for single factor is used to compare the differences among the D-dimer levels on day 1, 3, 5 and 21 of the menstruation cycle. The study has been reviewed and approved by the committee for ethics for research.

Results:

The results are summarized in table 1 and figure 1. There is no significant variation of D-dimer level measured on day 1, 3, 5, and 21 of menstruation cycle. (p = 0.382)

Conclusion:

The MDA D-dimer level does not have significant change during the menstruation period. The clotting process during menstruation may mainly be extravascular and, therefore, not affect the D-dimer level. Clinically, D-dimer test can still be used to rule out venous thromboembolism in a menstruating woman.

D-dimer levels (F.E.U./ml) on various days of menstruation cycle for 5 volunteers

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Subject Number .	2 .	3 .	4 .	5 .	6 .
Day 1	0.12	0.21	0.31	0.34	0.44
Day 3	0.10	0.18	0.23	0.13	0.31
Day 5	0.11	0.17	0.16	0.27	0.22
Day 21	0.21	0.10	0.17	0.39	0.29

Subject Number .	2 .	3 .	4 .	5 .	6 .
Day 1	0.12	0.21	0.31	0.34	0.44
Day 3	0.10	0.18	0.23	0.13	0.31
Day 5	0.11	0.17	0.16	0.27	0.22
Day 21	0.21	0.10	0.17	0.39	0.29

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