Pulmonary embolism laboratory findings

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Editor(s)-In-Chief: C. Michael Gibson, M.S., M.D. [1], The APEX Trial Investigators; Associate Editor(s)-in-Chief: Cafer Zorkun, M.D., Ph.D. [2]

Overview

The results of routine laboratory tests including arterial blood gas analysis are non-specific in making the diagnosis of pulmonary embolism. These laboratory studies can be obtained to rule-out other cause of chest discomfort and tachypnea. In patients with acute pulmonary embolism, non-specific lab findings include: leukocytosis, elevated ESR with an elevated serum LDH and serum transaminase (especially AST or SGOT).

Laboratory Findings

• Arterial blood gas
• Plasma D-dimer
  • Plasma D-dimer>500 ng/ml, PE present (Found to be 97% sensitive and 45% specific)
  • Plasma D-dimer<500 excludes PE (Have a high negative predictive value)
• Workup for hypercoagulation: which include
  • Activated protein C resistance
  • factor V Leiden mutation
  • Protein C
  • protein S, free and total.
  • Antithrombin
  • Lupus anticoagulant
  • Anticardiolipin antibodies
  • Plasma homocysteine values

• In patients with acute pulmonary embolism, routine laboratory findings are non-specific and include:
• Leukocytosis
• Elevated ESR with an elevated serum LDH and serum transaminase (especially AST or SGOT).
• Serum bilirubin levels are found to be within normal limits.

• In patients with suspected pulmonary embolism, routine laboratory tests are ordered to exclude the secondary causes of PE. These tests include:

• Complete blood count
• Erythrocyte sedimentation rate
• Coagulation studies to assess for hypercoagulable states.
• Other screening tests such as renal function tests, liver function tests and electrolyte assessment.