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SHAHEED ZIAUR RAHMAN MEDICAL COLLEGE

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ISSN: 1607-5854
Research Article

Change in D-dimer Levels due to Chemotherapy in Patients with Hematological Malignancies: An Observational Study

Sarkar SK1*, Azam MS2, Kabir MA3, Reza S4, Shafi MIA5

1Dr. Surozit Kumar Sarkar, Associate Professor, Department of Hematology, Shaheed Ziaur Rahman Medical College, Bogura.

2Dr. Md. Shafiul Azam, Associate Professor, Department of Hematology, Shaheed Ziaur Rahman Medical College, Bogura

3Dr. Md. Ahsanul Kabir, Assistant Professor, Department of Biochemistry, Shaheed Ziaur Rahman Medical College, Bogura

4Dr. Samim Reza, Registrar, Department of Hematology, Shaheed Ziaur Rahman Medical College Hospital, Bogura

5Dr. Md. Imtiaz Al Shafi, Lecturer, Department of Physiology, Shaheed Ziaur Rahman Medical College, Bogura

*Corresponding author: drsurozit@yahoo.com

Abstract

Background: Elevated D-dimer levels are usually associated with a hypercoagulable state. Hematological malignancies are often associated with raised D-dimer but may not always be associated with altered coagulation. Chemotherapy may elevate D-dimer levels without clinically significant thrombosis. This study was conducted to evaluate pre- and post-chemotherapy D-dimer levels ie, its change with chemotherapy in patients with hematological malignancies and to explore associations with hematological parameter and socio-demographical factors.
Methods: This cross sectional observational study was conducted at the Department of Hematology, Shaheed Ziaur Rahman Medical College Hospital, Bogura, from December 2023 to November 2024. Fifty patients with newly diagnosed hematological malignancies were enrolled. D-dimer levels were measured before chemotherapy and on 3rd post-chemotherapy day. Statistical analysis was done using paired ‘t’ test, ANOVA test and Pearson’s correlation coefficient test; p<0.05 was considered as level of significance.
Results: The sample had a mean age of 35.7±22.8 years, predominantly male (58%), with T-ALL (44%) and B-ALL (32%) being the most common subtypes. Mean D-dimer increased slightly from 2.16±2.70 µg/ml pre-chemotherapy to 2.22±2.47 µg/ml post-chemotherapy (p = 0.893), indicating no significant overall change. Subgroup analyses showed the highest post-treatment D-dimer in T-ALL, though differences across disease groups were non-significant. Post-chemotherapy D-dimer change correlated significantly with pretreatment D-dimer (p=0.028). Pre-treatment D-dimer correlated positively with anemia severity (r=0.29, p=0.041) and negatively with platelet count (r=–0.32, p=0.022), while post-treatment levels correlated with age (r=0.29, p=0.042).
Conclusion: Hematological malignancies exhibit elevated D-dimer levels both before and after chemotherapy without clinically significant thrombosis. Chemotherapy significantly raised D-dimer levels. Correlations with anemia, platelet count, and age may highlight its potentiality as a biomarker of baseline disease state rather than immediate treatment response. So, raised D-dimer in hematological malignancies should be interpreted cautiously especially in absence of clinically significant thrombosis.

Keywords

D-dimer hematological malignancy chemotherapy hypercoagulability anemia platelet count.

1. INTRODUCTION

Hematological malignancies, including leukaemias, lymphomas, and multiple myeloma, are frequently accompanied by coagulation abnormalities. A key biomarker of such dysregulation is the elevation of D-dimer, a fibrin degradation product reflecting ongoing activation of coagulation and fibrinolysis 1,2. In cancer patients, elevated D-dimer levels are associated with increased risk of thrombosis, poor prognosis, and reduced overall survival3,4.
This abnormal biochemical result creates a confusion whether to start thrombolytic or not in critical thrombocytopenic patient or stable asymptomatic patient. It also to be remembered by the clinicians that pregnancy, trauma, malignancy, surgery, and liver disease can all cause elevations of the D-dimer5.
In patients with hematological malignancies, the mechanisms contributing to D-dimer elevation are multifactorial. The malignant transformation of hematopoietic cells can promote a prothrombotic micro-environment through the release of cytokines, activation of endothelial cells, and expression of tissue factor. Additionally, bone marrow infiltration and systemic inflammation further exacerbate coagulation activation 1,2.
Chemotherapy can induce and exacerbate coagulation activation by inducing endothelial injury, triggering inflammatory cytokine cascades, and promoting tumor cell lysis, all of which contribute to elevated D-dimer levels during and after treatment 6. Consequently, fluctuations in D-dimer concentrations before and after chemotherapy may reflect both disease burden and treatment-related physiological stress.
While previous studies have documented elevated D-dimer in solid tumors, data on pre- and post-chemotherapy changes in hematological malignancies remain limited. Furthermore, the relationship between D-dimer and patient-specific factors such as anemia, platelet count, age, and gender has not been comprehensively evaluated.
Since anemia and thrombocytopenia are common in hematological malignancies, their interplay with coagulation activation warrants systematic investigation.
This study aimed at evaluating pre- and post-chemotherapy D-dimer status in:


Hematological malignancies,


Chemotherapy-induced changes,


Variations across different malignancy subtypes, and


Correlations with anemia, platelet count, age, and gender.

Published: January 2, 2026

DOI: 324654-5646

ISSN: 1607-5854

Article Information
Volume 45, Issue 1 (2026)
3-7
January 2, 2026
324654-5646
33
12
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