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I’m going to excerpt from a book, but its not MY book (although I DO talk about the more modern day Illuminati - and by that I mean, going back not further than the mid-1700s - in my book- among many other things).But this guy, Bill Cooper, has a unique view on a lot of these things which lends credibility to any investigation because he was deeply involved in Naval and other Intelligence agencies through the instrumentality of his service in the Armed Forces.(Cooper says that he himself was a member of one of these secret combinations - which is what *I* call them - and that he speculates in his book that this may well have been a reason that he was picked for this kind of duty consistently during his period of service)What follows are EXCERPTS from his work BEHOLD, A PALE HORSE: and as pertains to your question, what you will see in the things Cooper says, is that Cooper seems to go far afield from the Illuminati proper (and for the purpose of making a more complete response, I include that “in”); and it seems to be his intention to enumerate and then connect miscellaneous various secret organizations to, not THE ILLUMINATI, as such - but RATHER, the greater concept of ILLUMINISM - which goes back MUCH further; so in responding to this question, the reader will, it is hoped, see that the REAL IDEA is not “THE ILLUMINATI” PER SE - but a LARGER PREMISE - which goes back much much further in time - to which all these secret combinations subscribe - called ILLUMINISM.So here we go with Cooper’s comments; and afterwards, I will have more to say which will add a little bit on a specific group that Cooper mentions, which is from my own research and writing:“Adam Weishaupt, a young professor of canon law at Ingolstadt University in Germany, was a Jesuit priest and an initiate of the Illuminati. The branch of the Order he founded in Germany in 1776 was the same Illuminati previously discussed. The Jesuit connection is important, as you will see later in this chapter. Researchers agree that he was financed by the House of Rothschild (the same Rothschild family mentioned in "Silent Weapons for Quiet Wars"). Weishaupt advocated "abolition of all ordered national governments, abolition of inheritance, abolition of private property, abolition of patriotism, abolition of the individual home and family life as the cell from which all civilizations have stemmed, and abolition of all religions established and existing so that the Luciferian ideology of totalitarianism may be imposed on mankind." In the same year that he founded the Illuminati…[Adam Smith] published Wealth of Nations, the book that provided the ideological foundation for capitalism and for the Industrial Revolution. It is no accident that the Declaration of Independence was written in the same year. On the obverse of the Great Seal of the United States the wise will recognize the all-seeing eye and other signs of the Brotherhood of the Snake. Every tenet was the same. Date and beliefs confirm that Weishaupt's Illuminati is the same as the Afghan Illuminated Ones (The Roshinaya) and the other cults which called themselves "illuminated." The Alumbrados of Spain were the same - as were the "illuminated" Guerinets of France. In the United States they were known as the Jacobin clubs.“Secrets within secrets within secrets — but always at the heart is the Brotherhood.“[some believe]…Weishaupt was betrayed and set up for persecution because he ignored the rule that the word "illuminati" or the existence of the Brotherhood would never be exposed to public knowledge. His exposure and outlawing accomplished several goals of the still-hidden and still very powerful brotherhood. It allowed members to debunk claims of its existence on the grounds that the Illuminati had been exposed and outlawed and thus was no longer a reality. It allowed members to deny allegations of conspiracy of any kind. The Brotherhood of the Snake is adept at throwing out decoys to keep the dogs at bay.“Weishaupt may have been a fool — OR, he may have been doing exactly what he was told.“Weishaupt said, "The great strength of our Order lies in its concealment; let it never appear in its own name, but always covered by another name, and another occupation."“Allegations that the Freemason organizations were infiltrated by the Illuminati during Weishaupt's reign are hogwash. The Freemasons have always contained the core of Illuminati within their ranks, and that is why they so freely and so willingly took in and hid the members of Weishaupt's group.“You cannot really believe that the Freemasons, if they were only a simple fraternal organization, would have risked everything, including their very lives, by taking in and hiding outlaws who had been condemned by the monarchies of Europe.“It is mainly Freemason authors who have perpetuated the myth that Adam Weishaupt was the founder of the Illuminati and that the Illuminati was destroyed, never to surface again. The Masons are major players in the struggle for world domination….“The 33rd Degree is split into two. One split contains the core of the Luciferian Illuminati and the other contains those who have no knowledge of it whatsoever. ALL of the intelligence officers that I worked for while in Naval Intelligence were Masons.“Most members of the Freemasons are not aware that the Illuminati practices what is known as "secrets within secrets," or organizations within organizations. That is one purpose of initiation.“I firmly believe that all adult secret societies that practice degrees of initiation and consider the members to be "illuminated" are branches of the original ages-old Illuminati. Their goal is to rule the world. The doctrine of this group is not democracy or communism, but is a form of fascism.(Editor Note: Arguably, without the network of the southern jurisdiction Scottish Rite of Freemasonry, getting the South into the mindset and position where it could decide to secede from the Union, COULD NOT HAVE OCCURRED. There were some other networks – Yale’s Skull and Bones network had quite a bit to do with this – but all these other networks were under the general umbrella of the southern jurisdiction of the Scottish Rite of Freemasonry. So what was operating, ante-bellum, was a lot of Skull and Bones type, Scottish Rite Freemasonry, British influence, esp. in South Carolina – all of these interests wanted the U.S. to split up, right? For various nefarious reasons).OK - back to Cooper:“You must begin to think correctly.“The Illuminati are not Communists, but some Communists are Illuminati. (1) Monarchism (thesis) faced democracy (antithesis) in WWI, which resulted in the formation of communism and the League of Nations (synthesis). (2) Democracy and communism (thesis) faced fascism (antithesis) in WWII and resulted in a more powerful United Nations (synthesis). (3) Capitalism (thesis) now faces communism (antithesis) and the result will be the New World Order...“The 1953 report of the California Senate Investigating Committee on Education stated: "So-called modern Communism is apparently the same hypocritical world conspiracy to destroy civilization that was founded by the Illuminati, and that raised its head in our colonies here at the critical period before the adoption of our Constitution." The California Senate understood that communism is the work of the Illuminati. They failed to realize that the Council on Foreign Relations and the Trilateral Commission are also the work of the Illuminati.“YOU MUST BEGIN TO THINK CORRECTLY.(Ed. Note: AND SO SAY I ALSO)“The enemy is not communism, it is ILLUMINISM.“The Communists are not going to be much happier with the New World Order than we. I hope to show that most modern secret societies and especially those that practice degrees of initiation — and that is the key — are really one society with one purpose. You may call them whatever you wish — the Order of the Quest, the JASON Society, the Roshinaya, the Qabbalah, the Knights Templar, the Knights of Malta, the Knights of Columbus, the Jesuits, the Masons, the Ancient and Mystical Order of Rosae Crucis, the Illuminati, the Nazi Party, the Communist Party, the Executive Members of the Council on Foreign Relations, The Group, the Brotherhood of the Dragon, the Rosicrucians, the Royal Institute of International Affairs, the Trilateral Commission, the Bilderberg Group, the Open Friendly Secret Society (the Vatican), the Russell Trust, the Skull & Bones, the Scroll & Key, the Order — THEY ARE ALL THE SAME and ALL WORK TOWARD THE SAME ULTIMATE GOAL - a New World Order.“In 1952 an alliance was formed, bringing them all together for the first time in history. The Black Families, the Illuminati (the Order), the Vatican, and the Freemasons now work together to bring about the New World Order. All will protest their innocence…“You may notice that some of those listed in the preceding paragraphs do not, or so it appears, practice degrees of initiation. That is the public view. Look at the Council on Foreign Relations. Many members—in fact, the majority — never serve on the executive committees. They never go through any initiation of any kind. They are, in fact, the power base and are used to gain a consensus of opinion. The majority are not really members but are made to feel as if they are. In reality they are being used and are unwilling or unable to understand. The Executive Committee is an inner core of intimate associates, members of a secret society called the Order of the Quest, also known as the JASON Society, devoted to a common purpose. The members are an outer circle on whom the inner core acts by personal persuasion, patronage and social pressure. That is how they bought Henry Kissinger. Rockefeller gave Kissinger a grant of $50,000 in the early '50s, a fortune in those days, and made dear old Henry a member of the CFR. Anyone in the outer circle who does not toe the mark is summarily expelled and the lesson is not lost on those who remain. Do you remember the human desire to be a member of the elect? That is the principle at work.“The real power are men who are always recruited without exception from the secret societies of Harvard and Yale known as the Skull & Bones and the Scroll & Key. Both societies are secret branches (also called the Brotherhood of Death) of what is otherwise historically known as the Illuminati. They are connected to parent organizations in England (The Group of Oxford University and especially All Souls College), and Germany (the Thule Society, also called the Brotherhood of Death).“I learned this when I was with Naval Intelligence.“I was not able to explain why some members of the Executive Committee were not listed under the "Addresses" of Chapter 322 of the Skull & Bones Society until I read The Wise Men by Walter Isaacson & Evan Thomas, Simon and Schuster, New York. Under illustration #9 in the center of the book you will find the caption "Lovett with the Yale Unit, above far right, and on the beach: His initiation into Skull and Bones came at an air base near Dunkirk." I have found that members of these two societies were chosen on an ongoing basis by invitation based upon merit post-college and were not confined to only Harvard orY>ale attendees. Only members of the Order are initiated into the Order of the Quest, the JASON Society that makes up the executive members of the Council on Foreign Relations and, in fact, the Trilateral Commission as well. The executive members of the Council on Foreign Relations are the real elect in this country. George Bush is a member of the Order. Surprised? You shouldn't be. His father was also a member who helped finance Hitler.“It is important that you know that the members of the Order take an oath that absolves them from any allegiance to any nation or king or government or constitution, and that includes the negating of any subsequent oath of allegiance which they may be required to take. They swear allegiance only to the Order and its goal of a New World Order.“George Bush (to use one example) is not a loyal citizen of the United States but instead is loyal only to the destruction of the United States and to the formation of the New World Order. According to the oath Bush took when he was initiated into Skull & Bones, his oath of office as President of the United States of America means nothing.“The Trilateral Commission is an elite group of some 300 very prominent business, political, and intellectual decision-makers of Western Europe, North America, and Japan. This enterprise is a private agency that works to build up political and economic cooperation among the three regions. Its grand design, which it no longer hides, is a New World Order. The Trilateral Commission was the idea of its founder, American banking magnate David Rockefeller. The real reason for its formation was the decline of the Council on Foreign Relation's power as a result of the people's dissatisfaction with the Vietnam War. The reasoning behind the move toward the Trilateral Commission was the same as entering two horses in the same race. It doubles the chances of winning. The real power has always remained solidly in the hands of the Council on Foreign Relations. The Rockefeller family was, is and always will be the benefactor of both organizations. Rockefeller, though powerful, is not in control in this country or anywhere else. The key to the REAL power is the fact that Rockefeller had to put out feelers at a Bilderberg Group meeting in 1972 about forming a private group of trilateral leaders.“The Bilderberg Group gave the nod and Rockefeller's man Zbigniew Brzezinski gathered up a membership and organized the Trilateral Commission in 1972, not in 1973 as the Commission claims. A key to the danger presented by the Trilateral Commission is its "Seminal Peace," written for them by Harvard Professor Samuel P. Huntington in the mid '70s. In the paper Professor Huntington recommended that democracy and economic development be discarded as outdated ideas. He wrote as co-author of the book Crises In Democracy, "We have come to recognize that there are potential desirable limits to economic growth. There are also potentially desirable limits to the indefinite extension of political democracy. A government which lacks authority will have little ability short of cataclysmic crisis to impose on its people the sacrifices which may be necessary." The crises and sacrifices he talks about will be discussed in a later chapter. Remember that George Bush was a member of the Trilateral Commission and only resigned as an expediency to get elected. He believes wholeheartedly in the Commission and its ideas and ideals. We…elected a President who believes that democracy and economic development must be discarded…Bush is still a member of the Order and the CFR.“The JASON Society, or JASON Scholars, takes its name from the story of Jason and the Golden Fleece, and it is a branch of the Order of the Quest, One of the highest degrees in the Illuminati. The golden fleece takes on the role of truth to JASON members. Jason represents the search for the truth. Therefore the name JASON Society denotes a group of men who are engaged in a search for the truth. The name Jason is spelled with capital letters when used as the name of the JASON Society. Lower-case letters are never used when referring to this secret group. Author's note: The name may even have a deeper meaning, as the name "Jason" and the Golden Fleece appear throughout history in relation to various other secret societies. In these instances the story represents man (Jason) looking for himself (Golden Fleece). Top Secret documents that I read while with Naval Intelligence stated that President Eisenhower had commissioned the JASON Society to examine all of the evidence, facts, lies, and deception and find the truth of the alien question. Founders of the JASON Group (not the same as the JASON Society) include members of the famous Manhattan Project, which brought together almost every leading physicist in the nation to build the atomic bomb during World War II. The group is made up mostly of theoretical physicists and is the most elite gathering of scientific minds in the United States. As of 1987 the membership included four Nobel Prize winners. Today JASON continues to offer scientific help the government cannot find anywhere else. They are probably the only group of scientists in the United States that know the true state of highest technology. JASON is shrouded in what appears to be unnecessary secrecy. The group refuses to release its membership list. None of the members list JASON membership on their official resumes. Working completely behind the scenes, JASON has guided the nation's most important security decisions. These include, but are not limited to, Star Wars, submarine warfare, and predictions about the greenhouse effect….[a]ccording to the Pentagon, the JASONS hold the highest and most restrictive security clearances in the nation. They are given the protocol rank of rear admiral (two stars) when they visit or travel aboard ships or visit military bases. The only other reference to the JASON group that I have been able to find is in The Pentagon Papers. The papers stated that JASON was responsible for designing the electronic barrier between North and South Vietnam for the purpose of sealing off infiltration of the South by North Vietnamese regulars during the Vietnam War. I was stationed on the DMZ and I can tell you that it did not work. The veil of secrecy drawn around the JASON Group has been so tight and so leak-proof since its conception that those who think the government cannot keep a secret need to reexamine that position.“The government was able to contain the JASON secret except for the one leak; but the JASON Group itself, a civilian group, did even better. No leaks have ever occurred from within JASON.“JASON is administered by the Mitre Corporation. Government contracts allotted to the Mitre Corporation are in reality allotted to the JASON scientists. This is done so that the name JASON does not ever appear in documents which may come under public scrutiny. What is the difference between the JASON Scholars or JASON Society and the JASON Group? The documents that I read referred to the JASON Society in exactly those words. In public documents the only JASON reference is to the JASON Group, administered by the Mitre Corporation. I believe the JASON Society is one of the highest degrees above the Skull & Bones and the Scroll & Key in the Illuminati. In other words, it is a higher level of initiation. The JASON Group is a scientific organization formed and hired by the JASON Society and the U.S. Government for obvious reasons. I know a lot more about the JASON Society and the JASON Group, but I do not want to injure Mr. Grant Cameron, who has done extensive research on these subjects. He will publish his research in the coming months. I guarantee his findings will amaze you. The Council on Foreign Relations has been the foremost flank of America's foreign-policy establishment for more than half a century. The Council on Foreign Relations is a private organization of business executives, scholars, and political leaders that studies global problems and plays a key role in developing U.S. foreign policy. The CFR is one of the most powerful semi-official groups concerned with America's role in international affairs. It is controlled by an elect group of men recruited from the Skull & Bones and the Scroll & Key societies of Harvard and Yale, which are both chapters of a secret branch of the Illuminati known as Chapter 322 of the Order….“The members of the Order make up the Executive Committee of the Council on Foreign Relations after undergoing initiation into the Order of the Quest, also known as the JASON Society. The Council on Foreign Relations is an off-shoot sister organization to the British Royal Institute of International Affairs. Their goal is a New World Order. Although it existed as a dinner club in New York, it did not take on its present power until 1921, when it merged with the Royal Institute of International Affairs and received its financial base from J.R Morgan, the Carnegie Endowment, the Rockefeller family, and other Wall Street banking interests.“The Council on Foreign Relations controls our government. Through the years its members have infiltrated the entire executive branch, State Department, Justice Department, CIA, and the top ranks of the military. EVERY DIRECTOR OF THE CENTRAL INTELLIGENCE AGENCY HAS BEEN A MEMBER OF THE CFR. MOST PRESIDENTS SINCE ROOSEVELT HAVE BEEN MEMBERS. The members of the CFR dominate ownership of the press and most, if not all, of America's top journalists are members. The CFR does not conform to government policy. The government conforms to CFR policy.“The CFR is a secret society in that it forbids the taking of notes or the publishing of minutes of its meetings. Any member who divulges the subject or any part of any conversation or talk that took place during a meeting is terminated. The goal of the Council on Foreign Relations is a New World Order. George Bush is a member of the CFR.ATTENTION!OK, now this is me again for a moment making a quick comment - this next part of Cooper excerpt is at least as important to pay attention to as the foregoing - THESE guys are REALLY NOT GOOD GUYS and they are VERY MUCH active today, right up to the present time:“The Knights of Malta play a powerful role in this scenario. In the 1930s General Smedley Butler was recruited to help take over the White House. He was told that he was needed because of his general popularity with the military. General Butler blew the whistle and named several prominent Americans as part of the plot. At the top of the list was John J. Raskob, who was a founding member of the U.S. branch of the Knights of Malta. He was board chairman of General Motors. He was, at the time, the U.S. Treasurer of the Knights of Malta. Congressional hearings were held to investigate the plot, but none of those named, including Raskob, was ever called to testify and nothing ever came of the hearings. Although you will find this in the Congressional records, you will NEVER find it in ANY history book anywhere. It is significant that the Iran-Contra episode has many similarities to the 1930s plot. William Casey was a member of the Knights of Malta. William Casey, with the help of Vice President Bush, Anne Armstrong and Donald Regan, caused the President's Foreign Intelligence Advisory Board to be emasculated so that Bush, Casey, North and others could carry out their dirty deeds without oversight. They had also developed a plan to suspend the Constitution of the United States and were preparing to implement the plan when they were caught. These facts emerged from the hearings but were suppressed by the committee chairman, Senator Daniel Inouye of Hawaii. You must understand that tremendous power was involved in both attempts to overthrow the United States Government. William Casey was the Director of the CIA. He was a member of the CFR. Casey was a Knight of Malta. He was the head of Ronald Reagan's political campaign. He was head of the Securities and Exchange Commission. During the Nixon administration he was head of the Export-Import Bank. Casey arranged financing for the Kama River truck factory in the Soviet Union with 90% of the funds guaranteed or furnished by the U.S. taxpayer. This factory built military truck and tank engines for the Soviet Army. It was, and may still be, the largest factory in the world and could produce more heavy trucks than all U.S. factories together. I believe Casey was murdered. The Knights of Malta is a world organization with its threads weaving through business, banking, politics, the CIA, other intelligence organizations, P2, religion, education, law, military, think tanks, foundations, the United States Information Agency, the United Nations, and numerous other organizations. They are not the oldest but are one of the oldest branches of the Order of the Quest in existence. The world head of the Knights of Malta is elected for a life term, with the approval of the Pope. The Knights of Malta have their own Constitution and are sworn to work toward the establishment of a New World Order with the Pope at its head. Knights of Malta members are also powerful members of the CFR and the Trilateral Commission.The Vatican has been infiltrated over many years by the Illuminati. This is easily proven by the fact that in 1738 Pope Clement XII issued a Papal Bull which stated that any Catholic who became a Mason would be excommunicated, a very serious punishment. In 1884 Pope Leo XIII issued a proclamation stating that Masonry was one of the secret societies attempting to "revive the manners and customs of the pagans'' and "establish Satan's kingdom on Earth."(Cooper: Behold A Pale Horse; excerpts; interpolatory insertions are mine)ATTENTION!OK, now, this is ME, again, adding some stuff about the Knights and Sovereign Military Order of Malta.Comments on various Secret Societies: Leonard Leo, the executive vice president of the Federalist Society (these are the guys who REALLY choose our judges, folks) is a member of the Sovereign Military Order of Malta.What does this mean?It is essentially a society of European, titled nobility – feudal aristocrats -existing in today’s world -the branch that he is a part of is the Roman Catholic one, There’s also an equivalent of it in Britain called the Knights of Saint John of Jerusalem -there’s another one called the Knights of Malta, a Russian order, but this is actually the American version, and what we’re dealing with here is split from the various organizations into different parts. It goes back to the Crusades, back to 10, 11, 1200 A.D., when they were the Hospitaliers of Jerusalem. It’s sovereign, aristocratic order. It is considered to be independent state. It had diplomatic relations with 107 countries. They have their own embassies.What do they do?They claim they do humanitarian work: medical emergencies; national disasters. In Germany you will see their ambulances. Look up the Maltese Cross.They have passports.They have a diplomatic pouch.They can go around the customs and the border patrols of the countries that they are in.They have License plates.Stamps.Coins.They have a LOT of the attributes of a sovereign state.There is a huge controversy about this, but it is not generally known.Up until recently the head of this group was Cardinal Raymond Leo Burke of the United States – Wisconsin. He was the overboss of the Sovereign Military Order of Malta, and then he became one of the leading critics of the Pope; he said that of formal censure of the Pope might be needed in consequence of his encyclical entitled Amoris Laetitia.Burke is a canon lawyer; he’s a reactionary; Cardinal; a Prelate – and he orchestrated a power play in that Burke tried to use some of his people in the Order to turn people against Francis. However, Pope Francis called in the main ally of Burke, and forced Burke’s guy to quit.Anyway: let me tell you who some of these people are: they are TITLED NOBILITY (you don’t get into this thing without that).(IMAGINE - in this day and age)1) the Prince and Grand Master, Giacomo Dell’Atore Del Tempio Del Sanguinetto; grand commander Ludwig Hauptmann von Rumerstein of Austria;2) Grand Chancellor Albrecht Freiherr von Burgerlager (an imperial Knight of the Holy Roman Empire);3) Grand Master of the Order was Matthew Festing (British) –4) The Grand Hospitaler is Dominic de la Rochefocault Mobel;5) the Receiver of the Common Treasure is Janos Count Esterhazy De Gallante.We ALL would do WELL to ask ourselves, in this time of political upheaval in the United States, just what exactly we are doing allowing people who have these kinds of connections to foreign (and in some cases FEUDAL) organizatoins and influences to do all the things that they are doing in the U.S., including, now, apparently choosing our judges, or having a SAY in choosing our judges, a’la my previous observation about Leo’s role in the Federalist Society.

Copied from Wikipedia:D-dimer (or D dimer) is a fibrin degradation product (or FDP), a small protein fragment present in the blood after a blood clot is degraded byfibrinolysis. It is so named because it contains two D fragments of the fibrinprotein joined by a cross-link.[1]D-dimer concentration may be determined by a blood test to help diagnose thrombosis. Since its introduction in the 1990s, it has become an important test performed in patients with suspected thrombotic disorders. While a negative result practically rules out thrombosis, a positive result can indicate thrombosis but does not rule out other potential causes. Its main use, therefore, is to exclude thromboembolic disease where the probability is low. In addition, it is used in the diagnosis of the blood disorder disseminated intravascular coagulation.[1]PrinciplesEditD-dimer formation. Shown are fibrinogen, with its one E domain and two D domains, acted upon in cascade, by the following enzymes: Thrombin, to create a mesh of fibrin protofibrils; Factor XIII tocrosslink the fibrin mesh (linking protofibril D domains), the scaffold for clot formation;Plasmin, whose action in fibrinolysis producesfibrin degradation products (FDPs), the smallest of which are D-dimers, protein fragments with one E and two crosslinked D domains from an original fibrinogen.[1]Coagulation, the formation of a blood clot or thrombus, occurs when the proteins of the coagulation cascade are activated, either by contact with damaged blood vessel wall and exposure to collagen in the tissue space (intrinsic pathway) or by activation offactor VII by tissue activating factors(extrinsic pathway). Both pathways lead to the generation of thrombin, an enzyme that turns the soluble blood protein fibrinogen into fibrin, which aggregates into proteofibrils. Another thrombin-generated enzyme, factor XIII, then crosslinks the fibrin proteofibrils at the D fragment site, leading to the formation of an insoluble gel which serves as a scaffold for blood clot formation.[1]The circulating enzyme plasmin, the main enzyme of fibrinolysis, cleaves the fibrin gel in a number of places. The resultant fragments, "high molecular weight polymers", are digested several times more by plasmin to lead to intermediate and then to small polymers (fibrin degradation products or FDPs). The cross-link between two D fragments remains intact, however, and these are exposed on the surface when the fibrin fragments are sufficiently digested. The typical D-dimer containing fragment contains two D domains and one E domain of the original fibrinogen molecule.[1]D-dimers are not normally present in human blood plasma, except when the coagulation system has been activated, for instance because of the presence ofthrombosis or disseminated intravascular coagulation. The D-dimer assay depends on the binding of amonoclonal antibody to a particularepitope on the D-dimer fragment. Several detection kits are commercially available; all of them rely on a different monoclonal antibody against D-dimer. For some of these, the area of the D-dimer to which the antibody binds is known. The binding of the antibody is then measured quantitatively by one of various laboratory methods.[1]IndicationsEditD-dimer testing is of clinical use when there is a suspicion of deep venous thrombosis (DVT), pulmonary embolism(PE) or disseminated intravascular coagulation (DIC).[2]It is under investigation in the diagnosis of aortic dissection.[3][4]For DVT and PE, there are possible various scoring systems that are used to determine the a priori clinical probability of these diseases; the best-known is the Wells score.[5]For a very high score, or pretest probability, a D-dimer will make little difference and anticoagulant therapy will be initiated regardless of test results, and additional testing for DVT or pulmonary embolism may be performed.For a moderate or low score, or pretest probability:A negative D-dimer test will virtually rule out thromboembolism: the degree to which the D-dimer reduces the probability of thrombotic disease is dependent on the test properties of the specific test used in the clinical setting: most available D-dimer tests with a negative result will reduce the probability of thromboembolic disease to less than 1% if the pretest probability is less than 15-20%. Chest computed tomography (CT angiography) should not be used to evaluate pulmonary embolism for persons with negative results of a D-dimer assay.[6]If the D-dimer reads high, then further testing (ultrasound of the leg veins or lung scintigraphy or CT scanning) is required to confirm the presence of thrombus. Anticoagulanttherapy may be started at this point or withheld until further tests confirm the diagnosis, depending on the clinical situation.In some hospitals, they are measured by laboratories after a form is completed showing the probability score and only if the probability score is low or intermediate. This reduces the need for unnecessary tests in those who are high-probability.[7]Performing the D-dimer test first can avoid a significant proportion of imaging tests and is less invasive. Since the D-dimer can exclude the need for imaging,specialty professional organizationsrecommend that physicians use D-dimer testing as an initial diagnostic.[8][9][10][11]InterpretationEditReference rangesEditFollowing are reference ranges for D-dimer:[12]UnitsNonpregnantadultFirsttrimesterSecond trimesterThird trimestermg/L or µg/mL< 0.50.05 - 0.950.32 - 1.290.13 -1.7µg/L or ng/mL< 50050 - 950320 - 1290130 - 1700nmol/L< 2.70.3 - 5.21.8 - 7.10.7 - 9.3Thrombotic diseaseEditVarious kits have a 93-95% sensitivity(true positive rate). For hospitalized patients, one study found the specificityto be about 50% (true negative rate) in the diagnosis of thrombotic disease.[13]False positive readings can be due to various causes: liver disease, highrheumatoid factor, inflammation,malignancy, trauma, pregnancy, recentsurgery as well as advanced age.[14]False negative readings can occur if the sample is taken either too early after thrombus formation or if testing is delayed for several days. Additionally, the presence of anti-coagulation can render the test negative because it prevents thrombus extension. The anti-coagulation medications dabigatranand rivaroxaban decrease D-dimer levels but do not interfere with the D-dimer assay.[15]False values may be obtained if the specimen collection tube is not sufficiently filled (false low value if underfilled and false high value if overfilled). This is due to the dilutional effect of the anticoagulant (the blood must be collected in a 9:1 blood to anticoagulant ratio).Likelihood ratios are derived from sensitivity and specificity to adjust pretest probability.In interpretation of the d-dimer, for patients over age 50 a value of (patient's age) x 10 μg/l may be abnormal.[16][17]HistoryEditD-dimer was originally described in the 1970s, and found its diagnostic application in the 1990s.[1]ReferencesEdit^ a b c d e f g Adam SS, Key NS, Greenberg CS (March 2009). "D-dimer antigen: current concepts and future prospects". Blood. 113 (13): 2878–2887. PMID 19008457.doi:10.1182/blood-2008-06-165845.^ General Practice Notebook > D-dimer Retrieved September 2011^ Suzuki T, Distante A, Eagle K (2010). "Biomarker-assisted diagnosis of acute aortic dissection: How far we have come and what to expect". Current Opinion in Cardiology. 25 (6): 541–545.PMID 20717014.doi:10.1097/HCO.0b013e32833e6e13.^ Ranasinghe AM, Bonser RS (2010). "Biomarkers in Acute Aortic Dissection and Other Aortic Syndromes". Journal of the American College of Cardiology. 56(19): 1535–1541. PMID 21029872.doi:10.1016/j.jacc.2010.01.076.^ Wells PS, Anderson DR, Rodger M, Forgie M, Kearon C, Dreyer J, Kovacs G, Mitchell M, Lewandowski B, Kovacs MJ (2003). "Evaluation of D-dimer in the diagnosis of suspected deep-vein thrombosis". N. Engl. J. Med. 349 (13): 1227–1235. 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"Current Diagnosis of Venous Thromboembolism in Primary Care: A Clinical Practice Guideline from the American Academy of Family Physicians and the American College of Physicians". The Annals of Family Medicine. 5 (1): 57–62. PMC 1783928 .PMID 17261865.doi:10.1370/afm.667.^ Reference Values During Pregnancy at Perinatology.com. Retrieved October 2014.^ Schrecengost JE, LeGallo RD, Boyd JC, Moons KG, Gonias SL, Rose CE, Bruns DE (September 2003). "Comparison of diagnostic accuracies in outpatients and hospitalized patients of D-dimer testing for the evaluation of suspected pulmonary embolism".Clinical Chemistry. 49 (9): 1483–1490.PMID 12928229.doi:10.1373/49.9.1483.^ Kabrhel C, Mark Courtney D, Camargo CA, Plewa MC, Nordenholz KE, Moore CL, Richman PB, Smithline HA, Beam DM, Kline JA (14 May 2010)."Factors Associated With Positive D-dimer Results in Patients Evaluated for Pulmonary Embolism". Academic Emergency Medicine. 17 (6): 589–597.PMC 3538031 . PMID 20624138.doi:10.1111/j.1553-2712.2010.00765.x.^ Baglin, Trevor; Keeling, David; Kitchen, Steve (2012). "Effects on routine coagulation screens and assessment of anticoagulant intensity in patients taking oral dabigatran or rivaroxaban: Guidance from the British Committee for Standards in Haematology". British Journal of Haematology. 159 (4): 427–429.ISSN 0007-1048. PMID 22970737.doi:10.1111/bjh.12052.^ van Es J, Mos I, Douma R, Erkens P, Durian M, Nizet T, van Houten A, Hofstee H, ten Cate H, Ullmann E, Büller H, Huisman M, Kamphuisen PW (2012)."The combination of four different clinical decision rules and an age-adjusted D-dimer cut-off increases the number of patients in whom acute pulmonary embolism can safely be excluded.". Thromb Haemost. 107 (1): 167–71. PMID 22072293.doi:10.1160/TH11-08-0587.^ Douma RA, le Gal G, Söhne M, Righini M, Kamphuisen PW, Perrier A, Kruip MJ, Bounameaux H, Büller HR, Roy PM (2010). 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