The D- Dimer and Ferritin Silent Life in Ascites: A Pilot Study

Abstract

Ascites, regardless of its source (hepatic, neoplastic, cardiac or inflammatory), is a clinical indicator of disease progression. In cirrhosis, ascites forms due to portal hypertension and low circulating blood albumin, which leads to so called third spacing. This study compared blood and ascites samples from 20 consecutive and unselected liver cirrhosis patients and 5 cancer patients.Significant correlations were found in cirrhotic ascites between albumin/D-dimer, albumin/ferritin, albumin/total protein, ferritin/Ddimer, total protein/ferritin, and total protein/D-dimer.Three out of five malignant ascites patients had low ascitic total protein values (below 25 g/L), whereas five out of twenty cirrhotic ascites patients had high values above 25 g/L. The protein composition of our oncology patients was likely altered due to treatment.Half of our cirrhotic patients and two cancer patients had high serum ferritin levels. We also observed ascitic ferritin levels up to 100 μg/l in half of the patients and values above the upper reference level for serum (280.00 μg/l) in six of our liver cirrhosis patients. Individual ascites values overlapped in cirrhotic and malignant ascites. D-dimer levels in ascites were 500-1000 times the plasma upper limit of normal (ULN) in three cancer patients and four cirrhosis patients.This study is the first to simultaneously examine ferritin and D-dimer levels in blood and uncomplicated ascites. Abnormal levels of D-dimer and ferritin in ascites, even in the absence of clinical symptoms, may indicate underlying processes in the ascitic peritoneal fluid such as inflammation and fibrinolysis. Additional research may be needed.