Every qualified doctor knows that it is most advisable to start the treatment of any patient with the collection of anamnesis, which is nothing more than a collection of information about the state of human health.
As a rule, any medical examination begins with a questioning of the patient himself about previous diseases or surgical interventions, about allergic reactions or hereditary predisposition to certain ailments, and so on.
Then the doctor prescribes a series of laboratory tests or simply tests that will help supplement the history with information about the development of the disease, as well as information necessary for choosing a method of treatment or further diagnosis.
(abbreviated coagulogram ) occupy an important place among laboratory blood tests, which are necessarily carried out in preparation for surgical intervention, for example, with a planned or during pregnancy .
Coagulogram - what is it?
Many patients in vain begin to worry when they hear from the attending physician such at first glance unusual words as coagulogram or else hemostasiogram ... So what is this coagulogram analysis and why is it taken?
First of all, it should be noted that this is a fairly common method of studying work in modern medicine. hemostatic system the human body, which is responsible for such important vital functions as: stopping bleeding when damaged blood clots or vessels , as well as maintaining a normal fluid state of the blood.
Hence the answer to the question of what it is hemostasiogram - a study that determines how well the hemostasis system of the body is functioning. A blood coagulogram test helps to study such an important function of the blood as the ability to coagulate, i.e. the formation of a blood clot.
Having received the results coagulology , the attending physician can predict in advance the outcome of the operation or delivery. Information about blood clotting is vital in emergency situations, for example, when a person is injured, when seconds are counting and must be stopped as soon as possible.
Therefore, it is hardly worth worrying too much about how much this study costs. After all, the price of a hemostasiogram cannot be compared with the confidence that the patient will be alive and well.
Indications for the appointment of such an analysis as a hemostasiogram are the presence of the following diseases in a patient:
- vascular thrombosis and lower limbs;
- cirrhosis chronic form;
- gestosis;
- inflammatory processes in the acute stage;
- hemorrhagic pathologies, for example, thrombocytopenia, hemophilia or von Willebrand disease.
In addition, such an analysis is necessarily prescribed to determine the rate of blood coagulation in preparation for elective operations, for example, a cesarean section, as well as during pregnancy to assess the state of hemostasis and before independent childbirth ... In the exchange card of each woman in labor, such a blood test as a coagulogram simply must be present.
Human hemostasis system
Having determined what this is an analysis for hemostasis, it is worthwhile to understand in more detail such a concept as blood clotting ... Perhaps we should start with a definition. So, the hemostasis system of the human body is the most important biological system, the main functions of which can be considered the preservation of the basic parameters of the blood, as well as stopping bleeding.
It is not for nothing that the human body is called the whole universe and is compared with a complex mechanism. And the hemostatic system can serve as just a vivid example of how ingeniously arranged people are. Blood is a unique biological fluid that can literally work miracles in our body.
It not only circulates through the vessels, but also imperceptibly restores veins and arteries throughout his life due to his ability to form blood clots or dense clumps, i.e. roll.
There are three main components of the human hemostasis system:
- Vascular cells endothelium (the inner layer, consisting of flat cells lining the lymphatic and blood vessels, as well as the heart cavity), which, when the vascular walls rupture or other damage, are able to release such biologically active components as prostacyclin, thrombomodulin and nitric oxide ... They, in turn, trigger the formation of blood clots.
- Platelets or platelets, which have the ability, as it were, to "stick" to each other in order to further form the primary hemostatic plug .
- Plasma factors (total 15 plasma factors, most are enzymes ), forming due to chemical reactions fibrin clot , which should finally stop bleeding.
Summing up all of the above, we can unequivocally answer the question of what a blood test for hemostasis shows during pregnancy, in preparation for a planned operation or during diagnostics. This analysis gives an idea of \u200b\u200bhow well or poorly the patient's blood clotting. In other words, how quickly doctors can stop bleeding when it occurs.
Decoding a blood coagulogram
A blood test for a coagulogram includes many different indicators that you need to be able to read correctly, i.e. understand and analyze, in other words, decipher. Unfortunately, not every doctor has the skills to decipher the hemostasiogram indicators. And only a highly qualified specialist can correctly interpret certain parameters of this analysis.
After conducting laboratory tests of the patient's blood and obtaining the results, the attending physician compares the decoding of the coagulogram with the norm established for adult patients, as well as children. It is important to remember that the rate of coagulogram for a child, man or pregnant woman is very different. This is primarily due to the peculiarities of the functioning of the body of people of different sexes in different age categories.
Coagulogram indicators
Consider the parameters of the blood clotting test, namely, the normal hemostasiogram indicators. Then we will dwell on each of them in more detail, and also talk about an expanded or expanded coagulogram.
It is worth noting that the table below shows several options for normal indicators of such hemostasiogram parameters as bleeding time and blood clotting time ... This is due to a different interpretation of the norm for these parameters by specialists studying them.
| Indicator name (abbreviated name) | Standard value of the indicator |
Blood clotting time:
|
|
Bleeding time:
|
|
| International Normalized Ratio (INR or INR) | 0,82-1,18 |
| Thrombin time (TV) | 14-21 seconds |
| Prothrombin index (PTI) | 73-122 % |
| Activated Recalcification Time (AVR) | 81-127 seconds |
| D-dimer | 250.10-500.55 ng / ml * |
| Quinck's prothrombin time (PT) | 11-15 seconds |
| Antithrombin III (AT III) | 75,8-125,6 % |
| Activated Partial Thromboplastin Time (APTT) | 22.5-35.5 seconds |
| Fibrinogen | 2.7-4.013 grams |
| Soluble fibrin-monomeric complexes (RFMK) | 0.355-0.479 UNIT * |
*International Unit (IU) or Action unit (UNIT) , i.e. a measure of the dose of a substance based on its biological activity.
*Nanograms per milliliter. Source: Wikipedia
Clotting time
This laboratory test of a patient's blood gives the doctor an idea of \u200b\u200bthe time it takes for the body to form a blood clot. There is no abbreviation for this parameter in the analysis. In the course of the research, the biological material (blood) taken from the patient from the vein is placed in a sterile and dry test tube, and then the time is noted and waited until a visible blood clot forms.
When the blood clotting time is normal, the doctor can conclude that the hemostasis system is working correctly, and also exclude some pathological conditions, for example, hemophilia or DIC syndrome in which a blood clot does not form at all. In case of a deviation from the norm of blood coagulation time (increase or decrease in indicators), one should understand the reasons in more detail.
For example, lengthening of bleeding time can be observed with hemophilia, systemic lupus erythematosus or at rheumatoid arthritis and also for peritonitis , with chronic liver pathologies , at pneumonia and the presence of a malignant tumor. Shortened bleeding time may signal development or hemorrhagic shock , as well as myxedema.
In addition, all indicators of the coagulogram, including this one, may deviate from the norm during pregnancy. As a rule, women first learn about the name of a blood clotting test during pregnancy, when they are mandatorily assigned many laboratory tests in order to monitor and quickly influence the health of the mother and the unborn child.
The changes that are rapidly occurring in the body of a pregnant woman do not pass without leaving a trace for the properties and characteristics of the blood. It is noteworthy that there is a gradual decrease in blood clotting time starting from the first trimester, and in the third trimester, this indicator can differ greatly from the norm. However, do not be afraid, since this is just one of the protective mechanisms that help prepare the female body for childbirth and reduce possible blood loss.
Bleeding time
In accordance with the norms, the duration of bleeding should not be less or more than a few minutes from the moment of puncture, the so-called primary hemostasis. To complete the process, i.e. the formation of a blood clot should take on average a maximum of 10 minutes. The blood clotting time is a very important indicator, which plays an important role in preparing a patient for surgery, for example, during a caesarean section.
The blood clotting rate in women does not differ from the standards established for adults. The rate of blood clotting in children depends on the age of the child. On average, the duration of bleeding should not exceed 2-4 minutes, and a blood clot should form within 2-5 minutes.
Bleeding time may be increased with:
- hemophilia;
- thrombocytopenia , i.e. with a lack of platelets in the blood;
- hemorrhagic fever , for example, for Ebole or Crimea-Congo;
- liver damage alcohol (intoxication);
- thrombocytopathy;
- drug overdose.
How to take a blood clotting test?
In order for the doctor to receive undistorted information after laboratory tests, one should correctly approach the delivery of any tests, including blood clotting. The biological material is taken in the morning, always on an empty stomach. It should be remembered that at least 8, and preferably 12 hours should have passed since the last meal.
In addition, it is worth refraining from taking alcoholic beverages and medications on the eve of the study, as this may affect the test result. If the patient is forced to take any medication, he should not forget to inform the medical professional about this.
Prothrombin time
What is prothrombin time? This is one of the main laboratory parameters of the coagulogram used by physicians to assess the hemostasis system of the human body as a whole, as well as to determine the effectiveness of drugs that prevent blood clotting.
PV reflects the 1st and 2nd phase of plasma coagulation. In other words, the time of formation of a thrombin clot in the blood when thromboplastin and calcium are added. For this parameter, the abbreviation PV is accepted; Such parameters of the blood clotting test as international normalized ratio (INR)
and prothrombin index (PTI)
are derived from prothrombin time, the rate of which differs depending on the age and gender of the patient.
For example, the norm for thrombin time in women and men is 11-15 seconds. For children, standards have been established depending on their age. For example, for newborn babies - 13-17 seconds or 14-19 seconds for premature babies. For an older child (from 10 years old), the norm is 12-16 seconds, and for a younger child - 13-16 seconds.
Thrombin time is above normal - what does it mean? A deviation from the standard indicators established for this parameter of the coagulogram may mean the following:
- disadvantage vitamin K in organism;
- low concentration or lack of clotting factors 1,2,5,7 as well as 10;
- violation in the normal functioning of the liver, liver failure or other diseases of this organ;
- availability DIC syndrome .
Prothrombin time is increased, what does this mean? As a rule, an excess of the PV indicator is associated with the patient's intake of medicines belonging to the group of anticoagulants, i.e. drugs that have anticoagulant properties, such as , Coumadinilin or .
International Normalized Ratio
Prothrombin ratio (abbreviated PTI) or INR in a blood test, what is it? You should start with a little background. Such a parameter as INR in a hemostasiogram appeared in 1983, when the World Health Organization (hereinafter referred to as WHO) decided to streamline the work of research laboratories and bring all indicators of the blood clotting test to a single understandable pattern for doctors around the world.
Previously, each laboratory could use different thromboplastin reagents , which could distort the final research results. This parameter of the coagulogram is abbreviated as INR or INR. In domestic medicine, at present, instead of INR, you can still find such an indicator as the prothrombin index, which reflects how well the patient's blood clots.
However, due to different methods for determining this parameter, it is considered unstable and therefore it is customary to use INR abroad. In a blood test for PTI and INR, the norm is set at the level:
- PTI - 70-100, and for patients taking Warfarin – 24,0-42,6;
- INR - 0.82-1.18.
So what is INR in a blood test? This is an indicator that is nothing more than the ratio of the PT of the patient's analysis and the PT of the control sample. The INR norm in a human blood test according to international standards can range from 0.82 to 1.18.
If deviating from the above values, the patient may be diagnosed with the following diseases:
- with increased PT and INR: chronic , deficit vitamin K, , amyloidosis, DIC syndrome, reduced level fibrinogen, nephrotic syndrome, coagulation factor deficiency (2.5, 7 and 10);
- with lowered PV and INR: thromboembolism , increased activity of factor 7, thrombosis or activation fibrinolysis.
In addition, an increase in the INR and PT value may indicate the presence of anticoagulant drugs in the patient's blood. Therefore, the INR rate when taking Warfarin differs from the established standards. For patients taking this drug and drugs similar to it in action, the following range of normal INR values \u200b\u200bis used - 2.0-3.0.
The norm of INR in blood in women usually does not differ from the general values. But while carrying a child, the female body changes so much that the INR rate during pregnancy may not coincide with the above indicated numbers.
Activated partial thrombin time
Blood test for aPTT - what it is? This is another indicator of the analysis that provides information about the effectiveness of the work of plasma factors, designed to quickly stop bleeding. This parameter is abbreviated as APTT.
APTT blood test
- what is it? Quite often there is such a name of the parameter as activated partial thromboplastin time. APTT, like aPTT, provide information about the rate of formation of a fibrin clot and best characterize the internal process of hemostasis. It is believed that the APTT indicator is the most accurate, but at the same time and the most sensitive, because may vary depending on the reagents used in laboratory research.
The general rate of APTT in human blood is set at 22.5-35.5 seconds. The APTT rate in women also corresponds to the above indicated values. However, as in the case with other parameters of the coagulogram, the APTT rate during pregnancy does not always correspond to the general rules. Consider the reasons for the deviation of this indicator from the norm.
When the above reasons are excluded, and the APTT is above normal, this means that the patient may experience such diseases as:
- fibrinolysis;
- acquired or possibly congenital deficiency of clotting factors (8, 9, 11, 10, 12, 2 and 5);
- DIC syndrome (2 or 3 stages);
- autoimmune pathologies (more often systemic lupus erythematosus );
- liver disease.
When the APTT is lowered what does it mean? If the value of the indicator is below normal, then this indicates that the ability of blood to clot is reduced. The main reasons for this condition may be:
- DIC syndrome 1 degree;
- increased coagulability;
- an error in the production of laboratory tests, for example, improper blood sampling.
Soluble fibrin-monomeric complexes
Abbreviated in the coagulogram is designated as RFMK. RFMK analysis, what is it? It's worth starting with the definition fibrin monomer complexes Are the breakdown products of a blood clot in the process fibrinolysis ... According to the researchers, this indicator is rather difficult to reliably determine, since soluble fibrin-monomeric complexes are very quickly removed from the blood.
A parameter such as RFMK plays an important role in diagnostics. DIC syndrome (full name - disseminated intravascular coagulation syndrome). The rate of RFMK in human blood is 0.355-0.479 U. However, during pregnancy, RFMK norms can differ significantly from the above indicated level. Since the female body is actively preparing for the upcoming childbirth, along with it, the basic parameters of blood change, including its ability to coagulate.
It is a kind of defense mechanism that helps minimize the risk of bleeding. It is considered normal for the level of RFMK to deviate during pregnancy up to 5.1 ml. per 100 ml. blood. If RFMK is elevated, what do these test results mean?
When in the coagulogram of a patient's RFMK, the reasons may be as follows:
- thromboembolism deep veins of the extremities or pulmonary artery;
- sepsis;
- or preeclampsia during pregnancy;
- connective tissue pathology;
- renal failure in the chronic or acute stage.
An increase in this indicator is often found in patients who have recently undergone surgery. Therefore, in the postoperative period, the analysis for RFMK may deviate from the norm.
Activated recalcification time
Abbreviated in the analysis, ABP is designated and denotes the time required for the formation of fibrin in blood plasma saturated with platelets and calcium. This parameter is also used to assess the blood coagulation system as a whole. ABP reflects the interaction of cellular and plasma hemostasis links.
It is noteworthy that the value of this parameter may vary depending on the reagents used in laboratory studies. As a rule, a shortened recalcification time indicates a patient's tendency to form blood clots, and an extended one - about hemophilia, as well as a decrease in the number of platelets and a change in their main characteristics.
Prothrombin index. Norm for women
The abbreviated name of this parameter in the analysis is PTI. IPT blood test - what is it? Prothrombin index Is the ratio of the established ideal prothrombin time to the prothrombin time in the patient analysis multiplied by 100%.
It is noteworthy that this indicator is currently almost not used, since WHO recommends using such a parameter, which is more resistant to laboratory research, as INR. The IPT rate in blood for a healthy person is set at 73-122%.
As a general rule, the PTI rate in women should not differ from the above values, with the exception of the pregnancy period, when blood clotting increases. Therefore, if there is a deviation from the norm of PTI in a woman in a coagulogram, you should consult a doctor for advice. This parameter increases, as a rule, if there is not enough vitamin K in the human body, and there is also a deficiency of blood clotting factors.
In addition, an increase in PTI is due to treatment with anticoagulants such as , Warfarin or Neodikumarin as well as when receiving Heparin and its analogues. PTI decreases with liver damage, for example, with cirrhosis and hepatitis, with vascular thrombosis and during pregnancy.
The rate of prothrombin for women in the blood
In the hemostatic system, 15 coagulation factors play a fundamental role, i.e. substances that characterize the correctness of its work. One of the most important factors is considered prothrombin or factor II, also known as thrombogen ... This is a protein that is a precursor of thrombin, which in turn is responsible for the blood clotting function - it stimulates the formation of a thrombus (blood clot).
The level of prothrombin in the blood is determined using the following tests:
- PV according to Quick - the norm for women is 78-142%;
- INR or INR - the norm for women is 0.85-1.15.
If the factor II level is higher than normal, then blood circulation becomes difficult due to the fact that the blood becomes viscous, as a result, the blood vessels become clogged. In this condition, the patient's body is at risk more than ever. strokes and heart attacks , and also significantly increases the risk of developing malignant tumors or thromboembolism .
In the case when the level thrombogen reduced, the formation of a blood clot occurs abnormally slowly, which is fraught with significant blood loss in the event of bleeding. As a rule, the reasons for such a failure in the hemostasis system are: lack of vitamin K in the body or other congenital and acquired factors.
Thrombin time
The abbreviated name is TV. This parameter characterizes the final stage of hemostasis and determines the length of time required for the formation of a clot. fibrin when added to blood plasma thrombin ... TB control is always carried out in combination with PT and APTT for the most effective diagnosis of pathologies of fibrinogens of a congenital nature, as well as for assessing the effectiveness of fibrinolytic and heparin therapy.
Fibrinogen
What is a fibrinogen blood test? First coagulation factor or fibrinogen Is nothing more than a protein formed under the influence hageman factor in the liver, and later, under its influence, is converted into insoluble fibrin ... The presence of fibrinogen is determined using a thrombotest.
It is believed that thrombotest grade 4 and 5 are normal. It is worth noting that since fibrinogen (an acute phase protein), its level rises in the blood during stress, injury or infection. As a general rule, the level of fibrinogen in the blood should be in the range from 2.7 to 4.013 grams. The rate of fibrinogen in women in the blood should not be lower or higher than the indicated values, with the exception of the period of pregnancy.
The blood parameters of a pregnant woman undergo changes, like her entire body as a whole. Many protective systems are launched, including the hemostasis system preparing for the upcoming delivery. Often, already in the first trimester, the level of fibrinogen may be slightly higher or lower than normal. For this period of pregnancy, indicators are set from 2.3 to 5 g / l.
When the level of this protein rises, the blood becomes denser and thicker. Because of this, the process of thrombus formation begins, which harms the child, because he will suffer from an acute lack of oxygen and, as a consequence, from a deficiency of important micro- and macroelements, as well as vitamins. During pregnancy in the second trimester, the fibrinogen index should be within the normal range of 2.4-5.1 g / l, and in the third trimester - up to 6.2 g / l.
An increased level of fibrinogen is also observed with:
- burn disease;
- menses;
- rheumatoid;
- amyloidosis;
- pneumonia;
- pyelonephritis;
- systemic scleroderma;
- peritonitis.
In addition, drugs such as Heparin and oral contraceptives.
A low level of fibrinogen indicates that the patient has such diseases as:
- DIC syndrome;
- prostate cancer;
- cirrhosis of the liver and other organ pathologies;
Fibrinogen levels may decrease with poisoning Heparin as well as when taken by the patient anabolic steroids, androgens, and barbiturates .
Antithrombin III
This physiological anticoagulant is structurally related to glycoproteins , i.e. substances capable of inhibiting coagulation factors 9, 10 and 12 and thrombin. It is synthesized in liver cells. The standard indicators of this parameter of the coagulogram changes depending on the age of the patient.
For adults, an indicator of 75-125% will be normal, for newborns - 40-80%, for children from 10 to 16 years old - 80-120%, and up to 10 years old - 60-100%. If antithrombin 3 is lowered, what does this mean? A decrease in the level of this anticoagulant may be associated with the presence of such diseases in the patient as DIC syndrome, sepsis, ischemia, liver cirrhosis, thromboembolism or thrombosis.
In addition, antithrombin III may decrease in the last trimester of pregnancy and when the patient takes Heparin or fibrin inhibitors. When antithrombin 3 is elevated, inflammatory pathologies, for example, peritonitis, pyelonephritis and pneumonia, as well as hepatitis and deficiency vitamin K.
D-dimer
Another indicator of an extended coagulogram, with the help of which the doctor analyzes not only blood coagulability, but also the anticoagulant system of the human body. D-dimer Are split fibrin threads. Only the increased result of this parameter is important, which indicates the development of liver diseases in the patient's body, DIC syndrome, thrombosis, ischemia, arthritis, myocardial infarction.
In addition, an increase in the D-dimer index is a sign of heavy smokers.
What is a coagulogram during pregnancy? This is all the same coagulogram, which is necessarily prescribed to women during the period of bearing a child, as well as immediately before preparing for childbirth.
During pregnancy, the norm for all indicators of the blood clotting test does not correspond to the generally accepted values \u200b\u200bfor the body of a healthy adult.
This is due, first of all, to the fact that the hemostasis system of a pregnant woman undergoes serious changes, as well as her entire body as a whole due to the appearance of another circle of blood circulation - uteroplacental. An important role is played by the hormonal background, in which .
It is noteworthy that during pregnancy, the activity of such blood clotting factors as 7.8 and 10, as well as fibrinogen, significantly increases. This is a kind of natural defense mechanism designed to help increase the chances of a favorable birth outcome.
Fragments of fibrin are deposited on the walls of blood vessels and thus the fibrinolysis system is suppressed. This allows the female body to play it safe in case of placental abruption or miscarriage, with uterine bleeding and with the formation of intravascular blood clots.
Deciphering the indicators of the coagulogram during pregnancy
We talked about what a coagulogram is and why this analysis is taken. Now let's figure out how to properly undergo a hemostasiogram, so that, based on the results obtained, the doctor can draw the correct conclusion and choose an effective treatment plan.
So, if you need to do a blood clotting test, then remember the following rules:
A standard hemostasiogram can be done in most public health clinics, and an extended or detailed analysis is more often available at paid medical institutions. For example, in the Invitro laboratory, a coagulogram can be done quite quickly. As a rule, the result of the study can be taken after a couple of days. This is due to the need for the behavior of a number of chemical reactions that require certain time expenditures, which simply cannot be avoided.
However, in any case, you will get the result of a paid analysis on your hands much faster than in a government institution, where the laboratory is heavily loaded due to the influx of patients or there may not be some reagents necessary for the study. The cost of the analysis depends on the number of parameters that need to be studied and varies from 1000 to 3000 rubles.
A coagulogram (hemostasiogram) is a blood test that is performed to study the rate of its coagulability. Deciphering the blood coagulogram is of great importance in the preparation of the patient for surgery. It helps prevent serious complications such as bleeding. The study of coagulability is necessarily carried out during, as well as if there are diseases of the liver, heart and blood vessels in the anamnesis. The presence of autoimmune pathologies is also an indication for the study of blood coagulogram. The analysis allows you to establish the cause of the bleeding.
The blood coagulation system (hemostasis) protects a person from dangerous blood loss in case of violation of the integrity of the vascular walls against the background of traumatic injuries and surgical interventions. The nervous and endocrine systems are responsible for adequate hemostasis in the body. For blood to adequately perform its basic functions (supplying tissues with oxygen and nutrients and regulating body temperature), it must have normal rheological properties, i.e., fluidity. Hypocoagulation (decreased clotting) against the background of various pathologies can lead to life-threatening blood loss. Hypercoagulation causes the formation of blood clots (thrombi) that block the lumen of the vessels. As a result of thrombosis, tissue ischemia develops, leading, including to and.
The main components of the hemostasis system are:
- vascular endothelial cells;
- platelets;
- plasma factors.
How to donate blood for coagulogram
Blood is taken from a vein in the elbow area. To avoid distortions and misinterpretation of the results, you need to prepare for the analysis accordingly.
Basic rules that are important for the patient to follow:
- you cannot eat 8-12 hours before the analysis;
- on the eve, you should not overeat at night;
- alcohol, tea, juices and other drinks are excluded - you can only drink pure water;
- people with nicotine addiction should not smoke at least an hour before the analysis;
- it is important to exclude physical and mental stress 15 minutes before the analysis.
Important:if the patient is taking pharmacological anticoagulants, he must inform the doctor about it! If, in the process of taking material for the study of a blood coagulogram, dizziness appears or a fainting state begins to develop, you should immediately notify the health workers of the change in well-being.
When is a blood coagulogram necessary?
Indications for analysis:
Blood is taken with a sterile syringe or a special vacuum system. The tourniquet is not applied to the arm. Puncture should be atraumatic in order to avoid data distortion due to the ingress of a large amount of tissue thromboplastin into the material. Two tubes are filled with blood, but only the second is used for research. The sterile test tube contains the anticoagulant sodium citrate.
Coagulogram indicators: decoding
In a standard analysis for a coagulogram, a number of indicators are studied, which are evaluated in aggregate.
Clotting time - This is the time interval between the onset of bleeding and its stop during the formation of a fibrin clot. Capillary blood clots in 0.5-5 minutes, and venous blood - in 5-10. The duration of bleeding increases against the background of thrombocytopenia, hypovitaminosis C, liver pathologies and taking drugs from the group of indirect anticoagulants (including acetylsalicylic acid, Trental and Warfarin). The duration of coagulation is reduced after massive bleeding, and in women - and during use.
PTI (prothrombin index) reflects the ratio of the duration of blood coagulation in the norm to the coagulation time in the subject. Reference values \u200b\u200b(standard options) - from 97 to 100%. In pregnant women, the indicator increases (up to 150% and more), which is not a pathology. The PTI numbers allow you to identify the presence or absence of liver pathologies. The index rises while taking hormonal contraceptives. An increase in values \u200b\u200brelative to the norm indicates the risk of developing thrombosis, and a decrease in the probability of bleeding.
Important: in order for the prothrombin index to be normal, the body needs a constant alimentary intake.
Thrombin time reflects the rate of conversion of fibrinogen to fibrin. The normal interval is 15-18 seconds. A shortening of the time interval with a high degree of probability indicates an excess of fibrinogen, and its lengthening indicates a low concentration of this protein compound in serum or severe functional liver failure in the background or with.
Note: regular monitoring of this blood coagulogram indicator is very important in heparin therapy!
APTT (activated partial thromboplastin time) Is an indicator that reflects the duration of clot formation after adding CaCl2 (calcium chloride) to the plasma. Normal values \u200b\u200bare within 30-40 sec. Changes are noted when the other indicators of the blood coagulogram deviate within 30%. An extension of this time interval may indicate liver pathology or.
AVR (activated recalcification time) in a healthy person is from 50 to 70 seconds. The indicator allows you to assess the course of one of the stages of coagulation. A decrease in AVR is a sign of thrombophilia, and elongation is observed with thrombocytopenia, taking anticoagulants (heparin), serious injuries, extensive and the development of a shock state. A low AVR indicates an increased risk of massive and life-threatening bleeding.
GRP (plasma recalcification time) Is a coagulogram indicator that correlates with ABP and reflects the coagulation time of citrated serum after the addition of calcium salt preparations. Normal time is 1 to 2 minutes. Its reduction indicates an increased activity of hemostasis.
If the blood coagulogram shows a significant decrease in the indicator, this may be a sign of the following pathologies:
- violation of hemostasis;
- severe liver damage;
- toxicosis during the period of bearing a child;
- hypovitaminosis and deficiency.
The level falls with anticoagulant and anabolic therapy, as well as with the consumption of fish oil.
Fibrinogen B normally not detected.
Fibrinogen concentration in a healthy person - 5.9-11.7 μmol / l. Its decrease is noted in case of liver problems, and an increase is observed in malignant neoplasms and hypothyroidism.
RFMK indicator (soluble fibrin-monomeric complexes) characterizes the change in the structure of fibrin protein at the molecular level under the influence of coagulation factor II (thrombin) and plasmin. An indicator not exceeding 4 mg / 100 ml is considered normal. The variability of the indicator is due to the same reasons as the change in the concentration of fibrinogen.
Pay attention: RFMK is a marker that allows you to take timely measures to prevent the development of DIC.
Fibrinolytic activity - This is a coagulogram indicator reflecting the ability of the patient's blood to dissolve the formed blood clots. Responsible for this function is a component of the body's anticoagulant system - fibrinolysin. With its high concentration, the rate of dissolution of blood clots increases, respectively, bleeding increases.
Thrombotest allows you to visually determine the amount of fibrinogen in the test material. The norm is thrombotest grade 4-5.
Plasma Tolerance to Heparin Is a characteristic that reflects the time of formation of a fibrin clot after adding heparin to the test material. The reference value is from 7 to 15 minutes. The analysis reveals the level of thrombin in the blood. A decrease in the indicator with a high degree of probability indicates liver damage. If the interval is less than 7 minutes, cardiovascular disease or the presence of malignant neoplasms can be suspected. Hypercoagulation is typical for late pregnancy (III trimester) and post-surgical conditions.
Retraction of a blood clot characterizes a decrease in the volume of a blood clot with complete separation from the plasma. Reference values \u200b\u200brange from 44 to 65%. An increase in values \u200b\u200bis observed in various forms of anemia (anemia), and a decrease is a consequence of thrombocytopenia and erythrocytosis.
Duke bleeding duration - this is a separate analysis, during which not venous, but capillary blood is examined. The pad of the toe is deeply pierced (4 mm) with a special lancet. The blood that comes from the puncture is removed with special paper every 15-30 seconds (without contact with the skin). After each blotting time, the time until the next drop appears. The time for the cessation of bleeding from small blood vessels is normally from one and a half to two minutes. This indicator is influenced, in particular, by the level of the serotonin mediator.
Coagulogram of blood in children
The indicators of the blood coagulogram norm in children differ significantly from the normal values \u200b\u200bin adult patients. So, in newborn babies, the normal level of fibrinogen is from 1.25 to 3.0 g / l.
The indications for the study of the child's coagulogram are:
- suspicion of;
- diagnostics of pathologies of the hematopoietic system;
- the upcoming surgical intervention.
Coagulogram of blood during pregnancy
Important: during childbearing, a blood coagulogram study is carried out at least three times (in each trimester).
During pregnancy, hemostasis indicators normally change, which is caused by a significant hormonal change in the female body, an increase in the total volume of circulating blood and the formation of an additional (uteroplacental) circle of blood circulation.
In the first trimester, the clotting time, as a rule, increases significantly, and in the third trimester it is significantly shortened, thereby providing the woman with protection from possible blood loss during delivery. A blood coagulogram allows you to identify a threat or premature birth due to the formation of blood clots. Disorders from the coagulation system of a pregnant woman negatively affects the central nervous system of the unborn child.
Important: the presence of blood coagulogram data and their comparison with the norm allows obstetricians to take adequate measures to prevent serious bleeding during delivery.
A mandatory study of a blood coagulogram is necessary if a woman has vascular diseases (in particular -) or is diagnosed. A blood coagulogram is also studied with a decrease in immunity and a negative Rh factor.
Reference values \u200b\u200bof individual indicators of blood coagrams in pregnant women:
- thrombin time - 11-18 seconds;
- APTT - 17-20 sec .;
- fibrinogen - 6 g / l;
- prothrombin - 78-142%.
Important: A deviation of the prothrombin level from normal values \u200b\u200bmay indicate a placental abruption!
Lotin Alexander, medical columnist
A coagulogram or hemostasiogram is a blood test for its coagulability. It is carried out in children (if necessary) and in adults.
There are two types of hemostasiogram:
- basic (assigned at the beginning);
- expanded or extended (done in case of detection of a serious pathology during the basic coagulogram).
When do you need to take the test?
Usually, a coagulogram is not prescribed for everyone. The following groups of persons are subject to mandatory blood coagulation tests:
- patients before a planned abdominal surgery;
- pregnant women during the entire period of carrying a baby (a blood test is taken once every 3 months);
- people with diseases of the heart and blood vessels;
- patients with liver disease;
- people with autoimmune diseases;
- patients who have disorders in the blood coagulation system;
- those who are prescribed anticoagulant drugs or aspirin;
- women taking OC on a regular basis;
- patients who are shown course treatment with hirudotherapy.
Hemostasis in the human body
Blood clots in human vessels are not formed by chance: the hemostasis system was created to prevent the development of severe bleeding and preserve human life. A thrombus is blood particles (mainly platelets) adhered to the inner damaged wall of the vessel, which stick together and prevent blood loss. The body secretes thromboplastin, which forms a protein clot of fibrin. With a strong increase, you can see that it looks like the thinnest network in which platelets from the blood stream get stuck.
In addition to the coagulation system, there is also an anticoagulant in the human body, which controls the normal consistency of blood. The activity of these two systems controls fibrinolysis (resorption of blood clots after the vascular wall has healed). A detailed coagulogram will fully assess the work of all three systems. 
Basic terms and parameters of hemostasiogram
The table shows the most common indicators of a coagulogram:
|
Abbreviation |
Decoding |
|
Fibrinogen |
The most important marker that determines the state of the human blood coagulation system |
|
Prothrombin index - a study showing external coagulation |
|
|
International normalized ratio. The most versatile external blood clotting test. Coagulogram INR used most often. |
|
|
Prothrombin time is a laboratory test for external coagulation of the patient's blood. |
|
|
Activated partial thromboplastin time |
|
|
Thrombin time |
Time taken to complete the last clotting step |
|
Protein C |
A substance, lack of which in the blood can lead to the formation of severe blood clots |
|
Antithrombin |
The main protein factor of blood plasma |
|
D-dimer |
Particle that forms in the blood after a blood clot has been destroyed |
|
Lupus anticoagulant |
Antibodies formed in the blood serum of a person with an autoimmune disease |
|
Plasma Tolerance to Heparin |
Plasma heparin resistance |
|
Activated recalcification time |
|
|
RFMK |
Soluble fibrin monomeric complexes |
|
Plasma recalcification time |
The period of time required for fibrin synthesis |
Indicators of hemostasiogram. Norms and deviations
The table below shows the normal values \u200b\u200bof the coagulogram in an adult.
Below is a description of the most important indicators of the coagulogram, the norms and values \u200b\u200bof the indicators are indicated.
How to get tested correctly?
After receiving a referral from a doctor for a hemostasiogram, the patient is interested in how to take the test: on an empty stomach or not? A coagulogram is taken on an empty stomach early in the morning. You cannot eat at night, only drinking water is allowed. If the patient is taking any medication, it is necessary to indicate this upon delivery.
Blood is the main liquid medium of the body, and the quality of life and human health directly depends on its properties. One of the important properties of blood is fluidity, which ensures the ability to deliver nutrients to cells and participate in the process of removing metabolic products.
For the normal state of blood - its fluid is responsible for hemostasis - the coagulation system. Hemostasis maintains the necessary condition, preventing both life-threatening bleeding and the formation of blood clots. To assess the operation of this system, blood is examined for a coagulogram or as it is also called a hemostasiogram.
What is a coagulogram?
A coagulogram is a comprehensive diagnosis that studies individual indicators of blood clotting. The name itself is derived from two words - Latin coagulum, which means folding and Greek - gramma, which translates as a line or image. That is, based on this phrase, the study implies a digital expression or a graphic representation of the results obtained when assessing the coagulation indicators.
And if we consider the diagnosis in a broader sense, it turns out that the entire hemostatic system. The study of venous blood using coagulometry (which in translation means measurement of coagulability) makes it possible to draw a conclusion about the state and quality of functioning of the components of hemostasis. This includes anticoagulant, coagulation and fibrinolytic function.
A blood test for a coagulogram is carried out in order to assess the potential risks of hypo- and hypercoagulability, which is expressed in a decrease or increase in coagulability, and, therefore, the likelihood of bleeding or thrombosis. Correct and timely interpretation of the research data allows the doctor to assess the current condition of the patient, to predict the outcome of the operation and the prescribed therapy, and also to be prepared for delivery with possible complications.
In some cases, this analysis is almost the only guarantee for the patient. All parameters included in a comprehensive blood test for a coagulogram are considered indicative. There are 13 of them in total, but deviations from the normal indicators of any of them can lead to serious consequences for a person.
Table of parameters determined during hemostasiogram
When to analyze
There are quite a few indications for the appointment of a hemostasiogram, since deviations in the functioning of the coagulation system entail a large number of diseases. Therefore, the survey will be recommended in the following situations:
- assessing the activity of the hemostasis system;
- routine diagnostics before surgery;
- preparation for self-delivery or caesarean section;
- monitoring of severe gestosis occurring with complications;
- observation when taking oral contraceptives, anabolic steroids, glucocorticoid hormones;
- control of anticoagulation therapy with indirect drugs (Warfarin, Aspirin, Trental) and heparin therapy (Clexan, Fraxiparin).
Also, the technique is necessarily prescribed for the detection of diseases, as an initial screening and as a regular check. A hemostasiogram is used to determine or confirm:
- varicose veins of the lower extremities;
- DIC (disseminated intravascular coagulation) syndrome;
- chronic liver pathologies - cirrhosis and inflammatory processes;
- hemorrhagic diseases - hemophilia, thrombocytopenia and thrombocytopathy, von Willebrant disease);
- thrombosis of various organs - vessels of the lower and upper extremities, intestines, brain (strokes), pulmonary thromboembolism (TE).
A blood test for a coagulogram is always carried out in the presence of a high risk of thrombus formation. These diseases include coronary artery disease (CHD) and atrial fibrillation.
The sequence of the coagulation process
What is the preparation
To donate blood for clotting, the patient does not have to perform any complex actions, it is enough just to comply with a few simple conditions, such as:
- come with an empty stomach for the procedure, since the biomaterial is taken strictly on an empty stomach, and it will be correct to refrain from eating for at least 12 hours;
- at least a day before the study, exclude spicy, fried, fatty foods, as well as smoked meats, marinades and alcohol from the diet;
- at least an hour before donating blood, you should stop smoking.
In addition, it is recommended to stop taking direct and indirect anticoagulants, as their effect will affect the hemostasiogram parameters. Of course, such a cancellation authorization must be agreed with the attending physician. Indeed, in some cases, self-withdrawal of drugs of this action can lead to repeated thrombosis.
If the attending physician did not allow interrupting the drug intake for a day or two before the procedure, then the laboratory assistant of the diagnostic room should be notified of this before taking blood. All the necessary information can be obtained in advance by contacting the clinic chosen for the examination. The registry will tell you in detail where the blood is taken from, how much time is analyzed and will answer all questions of interest to the patient.
Blood sampling procedure
The algorithm for submitting a biomaterial to determine coagulation indicators is in many ways similar to a typical blood collection, but in some ways it differs from standard procedures. The basic rules to be followed when taking blood for a hemostasiogram:
- blood sampling is performed with a dry sterile syringe or a vacuum biomaterial sampling system "Vacutainer";
- for the procedure, a needle with a wide lumen is used, which allows not to use a tourniquet;
- the puncture of the vein must be clear - without damaging the nearby tissues, otherwise there will be an increased content of tissue prothrombin in the test tube, which will affect the reliability of the results;
- the laboratory assistant or nurse picks up 2 test tubes, but sends only the second one for research, which contains a special coagulant - sodium nitrate.
Where to donate blood and when will the results be ready?
It is possible to undergo blood diagnostics for a coagulogram in any diagnostic institution of a medical nature, both public and private, which has specialized equipment and the necessary reagents. This procedure is a rather difficult study in terms of interpretation, therefore, the decoding of the blood clotting test should be carried out by qualified doctors.
The cost of diagnostics depends on the number of determined indicators. The run time can also be lengthened, as each parameter requires a series of chemical reactions. In most cases, results are ready in 1-2 business days. In addition, the presence or absence of reagents, the workload of the laboratory or courier can affect the speed.
Interpretation of indicators
As mentioned above, a hemostasiogram is a very complex and informative analysis, and it is deciphered exclusively by specialized specialists. Sometimes the attending physician may prescribe several indicators for the study, which will be indicated in the direction, and in some cases, all parameters of the coagulogram are studied. These include the following.
Prothrombin time (PT)
The value shows the time interval for which, when thromboplastin and calcium are added to the plasma, a thrombin clot has time to form. The parameter determines the 1st and 2nd phase of plasma coagulation and the activity of the factors listed in the generally accepted tables under the numbers 2, 5, 7, 10.
PV norms for adults and children of different age categories
Important! Anticoagulant treatment is considered effective if PT increases by at least 1.5–2 times.
International normalized ratio (INR)
The indicator is the prothrombin coefficient, that is, the ratio of the PT of the subject to the PT of the control tube. This parameter was introduced by the WHO - World Health Organization to streamline the activities of laboratories in 1983, since each uses different reagents, thromboplastins. The main task of the INR is to control the condition of patients taking indirect anticoagulants.
The main reasons for the growth of PV and INR are:
- intestinal enteropathies, dysbiosis, accompanied by a lack of vitamin K;
- amyloidosis is a systemic disease characterized by impaired protein metabolism;
- genetically determined insufficiency of 2, 5, 7, 10 cohalation factors;
- coumarin-based medication therapy (Merevan, Warfarin);
- liver diseases - cirrhosis, chronic hepatitis;
- decline in concentration or absence of fibrinogen;
- Disseminated intravascular coagulation and nephrotic syndrome;
- the presence of anticoagulants in the blood.
These coefficients are reduced by:
- activation of the fibrinolysis function (dissolution of blood clots);
- thrombus formation in blood vessels and TE;
- increase in the work of 7 factors.
Activated partial thrombin time (APTT)
This value is also called the cephalinkolin time, and it determines the effectiveness of the functioning of plasma factors when bleeding stops. In other words, the APTT reflects the internal work of hemostasis, that is, the rate at which a fibrin clot is created. This is the most accurate and sensitive value of the coagulogram.
Its parameters, first of all, can vary from the reagents-activators used in a particular clinic. A decrease in the coefficient indicates an increase in coagulability, a tendency to thrombosis, and lengthening indicates a decrease in hemostasis function and the possibility of bleeding.
The reasons leading to the growth of APTT are:
- liver pathologies occurring in severe form - fatty infiltration, cirrhosis;
- congenital insufficiency of coagulation 2, 5, 8, 9, 10, 11, 12 factors;
- therapy with heparin and its derivatives (clexane, etc.);
- autoimmune systemic connective tissue diseases (SSTD) - systemic lupus erythematosus (SLE);
- excess of fibrinolysis activity;
- 2 and 3 degrees of disseminated intravascular coagulation.
And, conversely, the APTT decline is caused by:
- increased coagulation capacity;
- 1 stage of disseminated intravascular coagulation;
- ingestion of tissue thromboplastin into the blood sample with the wrong technique for taking biomaterial.
INR parameters that determine the required dose for a patient during warfarin therapy
Activated Recalcification Time (AVR)
The value reflects the time spent on the appearance of fibrin in plasma containing calcium and platelets, which indicates the quality of contact between the plasma and the components of hemostasis. The ATS ratio can vary depending on the reagents used.
Attention! An increase in the indicator is directly related to a decrease in the number of platelets, a change in quality characteristics, as well as hemophilia. A decline in AVR signals the possibility of thrombosis.
Prothrombin index (PTI)
The parameter displays the ratio of the ideal PTT to the identical value of a particular subject, multiplied by 100%. Recently, as a rule, experts refuse to determine this value and replace it with INR. IPR, like INR, smooths out differences in analytical responses arising from differences in reagents in laboratories. Changes in this parameter are in many ways similar to INR, that is, they are due to almost the same aspects.
Thrombin time (TV)
The value demonstrates the final stage of hemostasis - the rate of formation of a fibrin clot in plasma with the addition of thrombin. The indicator is one of the three obligatory factors for research together with APTT and PT, and is used to monitor heparin therapy and congenital fibrinogenic anomalies.
Among the states that increase TV are:
- the absence of fibrinogen or its drop to less than 0.5 g / l;
- taking fibrinolytic medications;
- autoimmune pathologies (with the production of antibodies to thrombin);
- chronic liver diseases - hepatitis, cirrhosis;
- acute fibrinolysis, disseminated intravascular coagulation syndrome.
A decrease in the indicator is observed with heparin therapy or the use of IPF (inhibitors of fibrin polymerization), as well as at the 1st stage of the development of DIC.
Table of factors by numbers and their main brief characteristics
Fibrinogen
This indicator, which is a protein compound, refers to 1 coagulation factor. It is synthesized in the liver, and when exposed to factor 7 (contact or Hageman) is transformed into insoluble fibrin. The appearance of fibrinogen is characteristic of the acute phase, when its level increases during trauma, inflammation, infections, and stressful situations.
An increase in fibrinogen concentration is caused by:
- severe inflammatory processes - peritonitis, pneumonia, pyelonephritis;
- myocardial infarction, oncological neoplasms, especially those localized in the lungs, amyloidosis;
- bearing a fetus and complications during pregnancy, menstruation;
- performed surgical operations, burn disease;
- therapy with heparin and its derivatives, as well as estrogens;
- SZST - scleroderma, SLE, rheumatoid arthritis;
- the use of oral contraceptives.
A decline in fibrinogen values \u200b\u200bis associated with the following conditions:
- congenital and acquired insufficiency;
- DIC syndrome, status after severe bleeding;
- liver disease due to alcoholism, cirrhosis;
- aplasia of the red bone marrow, leukemia;
- malignant neoplasm of the prostate gland;
- an excess of heparin - refers to acute conditions, and protamine, which is a fibrin antidote, is used for its therapy;
- taking anabolic steroids, barbiturates, valproic acid, androgens, fish oil, (IPF).
Soluble fibrin-monomeric complexes (RFMK)
RFMK is an intermediate result of dissolution of a fibrin clot, formed during fibrinolysis. They are quickly eliminated from plasma, so this parameter is rather difficult to study. Its main importance in terms of diagnosis is the early detection of DIC. The indicator is increasing:
- with thrombosis of different localization - deep veins of the arms or legs, TE of the pulmonary artery;
- acute and chronic forms of renal failure;
- complications of pregnancy - preeclampsia, preeclampsia;
- FTA, shock, sepsis, etc.
Important! There may also be an increase in RFMK in the postoperative period, which will indicate the development of abnormalities in hemostasis.
Antithrombin III
This blood component belongs to anticoagulants of physiological origin. It is a glycoprotein that inhibits thrombin and 9, 10, 12 coagulation factors. It is formed in hepatocytes (liver cells). This coefficient can increase in severe inflammatory pathologies - pyelonephritis, pneumonia, peritonitis, therapy with glucocorticoid drugs or anabolic steroids, acute damage to the liver parenchyma (for example, hepatitis), vitamin K deficiency.
Antithrombin III norm values \u200b\u200bfor different age categories
The decrease in values \u200b\u200bis noted due to:
- chronic pathological processes of the liver that have developed in connection with alcoholism (cirrhosis, etc.);
- Disseminated intravascular coagulation, ischemic heart disease, thrombosis and TE, sepsis;
- congenital or acquired deficiency;
- therapy with heparin and IPF.
Also, a decrease in this parameter is observed in pregnant women who are in the 3rd trimester.
Features of a coagulogram during pregnancy
During the period of gestation, multiple changes occur in the female body, affecting all systems, not excluding hemostasis. Such changes are due to a hormonal surge and the formation of a second circle of blood circulation. When a woman becomes pregnant, then the activity of 7, 8, 10 clotting factors, and especially fibrinogen, sharply increases.
There is a deposition of fibrin elements on the vascular walls of the uterus and placenta. Fibrinolysis is suppressed. Thus, the female body is insured in case there is uterine bleeding and there is a threat of spontaneous abortion. These changes are aimed at preventing placental abruption and the formation of blood clots in the vessels that feed the uterus, and, in particular, the fetus.
With pathological gestation - early and late gestosis, disorders of the functioning of hemostasis may develop. This is manifested in an increase in the activity of fibrinolysis or in a decrease in the life span of platelets. If a woman did not undergo examinations in time, such as a general (clinical), biochemical blood test, a coagulogram, and, therefore, did not receive qualified assistance, then the risk of developing DIC is very high.
Indicators of hemostasiogram during pregnancy
This pathology proceeds in three phases, which carry a serious threat to both the mother and the child. Hypercoagulation - the formation of many small clots in a woman's blood, causing impaired blood circulation between the mother and the fetus. Hypocoagulation - At this stage, clotting factors are depleted and the clots break down. Acoagulation is a lack of clotting function, which causes uterine bleeding, creating risks for the mother's life, and the child in such a situation most often dies.
Coagulogram - a set of tests, information about which makes it possible to determine the state of the blood coagulation system and those of its components, the activity of which is reflected in other systems of the body.
For the study, blood is needed, which is taken from a vein at the bend of the elbow. It is necessary to donate blood on an empty stomach. 8-12 hours must pass between meals and blood sampling. Juice, tea, coffee, especially sweetened coffee, is strictly prohibited to drink! Only water is allowed.
It is good if fatty, fried and alcoholic drinks are excluded from the diet 2 days before blood sampling. Try not to smoke one hour before taking blood.
It is advisable to negate the factors that can influence the research results: physical activity, emotional changes. Before the fence you need rest for 15 minutes, recover.
Blood is taken for analysis before the start of medication or 14 days after drug withdrawal. If you are undergoing drug therapy, be sure to inform your doctor about this.
If you are taking medications that affect blood clotting (aspirin, heparin, contraceptives, etc.), be sure to notify the laboratory assistant!
Coagulogram appointed in such cases:
- liver disease;
- examination during pregnancy;
- problems with the heart and blood vessels;
- deviations of the coagulation system;
- control during treatment with anticoagulants;
- diseases of the immune system;
- varicose veins of the lower extremities;
- period before and after surgery.
How does the blood clotting process take place?
Blood clotting - this is the body's defense against blood loss. When the tissue is cut or otherwise damaged, the blood cells are triggered and plugged to stop the blood. Such cells are called platelets. Normally, platelets do not manifest themselves in any way, because blood has a liquid consistency to move through the vessels.
A coagulogram study will normally give information about the ability of blood to remain liquid and at the same time form clots in case of injury. An increase in blood clotting causes consequences such as stroke and thrombosis.
If the doctor forces you to undergo such a study, then it is definitely worth doing. Violation of the blood clotting process may not have any manifestations for a long period.
Such violations are most often observed with diseases:
- diabetes;
- malignant tumors;
- rheumatism;
- chronic and acute lung diseases, etc.
Blood clotting process consists of such stages:
- In the presence of vascular damage, thromboplastin is released - a special substance that activates the coagulation reaction.
- Coagulation factors are triggered - proteins that are constantly normally present in the blood and contribute to the formation of a blood clot at the site of a violation of the integrity of the vessel.
- Thrombin activates an inactive protein called fibrinogen, converting it into active fibrin, which is the basis of the clot.
- Blood components, including platelets, are deposited in fibrin networks.
- The platelets thicken and compress the clot, creating a blood clot that closes the damaged vessel wall.
It also works to counteract the clotting system in the body. anti-coagulation system. Together they create the conditions for maintaining normal blood flow.
Coagulation study in pregnant women
It is even more important to correctly decipher the blood test during pregnancy. During pregnancy, the study will certainly show an increase in blood clotting, which is normal in a similar state. This is not a reason not to observe this indicator and neglect the analysis.
Changes in blood clotting can have an impact on the entire pregnancy, as well as on the child's brain, if these abnormalities are not detected at the right time. Therefore, the expectant mother needs to know what characteristics this analysis has in itself and what is the procedure for its delivery.
Testing procedure:
- On an empty stomach;
- Do not eat 8 hours before blood sampling;
- A venous blood sample is taken.
During pregnancy, the following indicators are checked in the coagulogram:
- fibrinogen - special protein. It tends to increase during the entire pregnancy, immediately before the birth itself. The maximum indicator is 6 g / l.
- activated partial thromboplastin time - during pregnancy should be below normal. Normally, when examining blood for a coagulogram, this indicator reaches 17-20 s.
- lupus anticoagulant shows antibodies that force the partial thromboplastin time to increase, so it should not be there during pregnancy. If the analysis shows a lupus anticoagulant, then this indicates a serious disease of the immune system.
Decoding a blood test for a coagulogram
For a standard coagulogram, the interpretation of the analysis results uses the indicators:
Fibrinogen
Fibrinogen is a protein synthesized by the liver and, under the influence of a specific blood factor, is converted into fibrin.
- determination of blood clotting disorders;
- preoperative examination and in the postoperative period;
- examination during pregnancy;
- control of blood during inflammation in the body.
Magnification fibrinogen indicates:
- increased coagulability;
- the risk of blood clots;
- observed at the end of pregnancy;
- postpartum condition;
- postoperative period;
- pneumonia;
- acute inflammations and infections;
- post-stroke condition;
- myocardial infarction;
- disruption of the thyroid gland;
- burns;
- taking contraceptives;
- some specific diseases.
Decline fibrinogen levels at:
- severe hepatitis, liver cirrhosis;
- dangerous pathologies of blood coagulation;
- complications of pregnancy;
- hypovitaminosis C or B12;
- taking hormones;
- androgens;
- anticoagulants;
- fish oil.
Activated partial thromboplastin time
Activated partial thromboplastin time - blood clotting time, depending on the presence of clotting factors, as well as on the concentration of heparin in the blood. The main function is to control the level of heparin during therapy with it, to specify the dosage.
Enhancement APTT:
- lack of clotting factors;
- the presence of a lupus anticoagulant;
- heparin;
- coagulation of blood in the vessels.
Deceleration of blood clotting due to an increase in the duration of APTT, the following occurs:
- with inhibition of blood clotting;
- with blood diseases;
- with other rare diseases.
Lupus anticoagulant
Lupus anticoagulant is a blood component that acts against phospholipids. This enzyme has such a name only because it was first discovered in the blood of patients suffering from lupus erythematosus. Normally, the amount of this enzyme reaches 1.2 units.
Excess norms indicate:
- antiphospholipid syndrome;
- the risk of blood clots;
- thromboembolism;
- infertility;
- immune diseases;
- systemic lupus erythematosus;
- pathology of blood circulation in the brain.
Prothrombin
Prothrombin is a compound protein, the most significant indicator of the coagulogram, which shows the functioning of the coagulation system. It precedes thrombin. Prothrombin is produced by the liver under the influence of vitamin K.
Based on the analysis of prothrombin, you can get status report:
- liver;
- digestive organs;
- blood coagulation system.
Prothrombin time
Prothrombin time - the time of stage 2 of coagulation - the conversion of prothrombin to thrombin.
Enhancement blood level:
- liver disease;
- hypovitaminosis K;
- lack of prothrombin and other clotting factors;
- coagulation of blood in the vessels.
Prothrombin index
The prothrombin index is the ratio of the clotting period of the plasma of a healthy person to the period of clotting of the patient's plasma. Measured in%. The normal range of fluctuations is from 93 to 107%.
The production of proteins of the prothrombin complex occurs in the liver, with its pathologies, the number of factors decreases. The prothrombin index is to some extent a characteristic of the state of this organ.
Magnification PTI shows:
- increased coagulability;
- the risk of thrombosis.
It can be observed normally at the end of pregnancy and when taking contraceptives.
Decrease in index suggests a decrease in blood clotting rates.
For the production of proteins of the prothrombin complex, vitamin K is needed. With its lack, deviation from the side of absorption of the vitamin in the intestine with colitis and dysbiosis, the indicator may also fall.
Exceeding the dose of acetylsalicylic acid, diuretics also help to reduce the prothrombin index.
Thrombin time
Thrombin time is the period during which fibrinogen is converted to fibrin. Normally, this is up to 18 seconds.
Magnification thrombin time occurs when:
- severe liver pathology;
- congenital lack of fibrinogen.
Decrease time is an indicator:
- an excess of fibrinogen;
- available paraproteins - special immunoglobulins.
The level of this indicator must be monitored during treatment with heparin and fibrin-containing drugs.
Antithrombin III
Antithrombin III is an anticoagulation protein. It is produced in the liver.
A drop in its concentration can cause thrombosis and ineffectiveness of heparin therapy.
Enhancement concentration at:
- acute hepatitis;
- obstructive jaundice;
- inflammation;
- menses.
Decrease:
- congenital defect;
- intravascular coagulation syndrome;
- hepatic abnormalities;
- risk of blood clots.
It is a protein and the opposite of thrombin. Its function is to suppress the action of the coagulation system. This indicator is measured as a percentage. The norm is from 71 to 115 percent.
With increased blood clotting, anticoagulants are prescribed. In such a situation, you also need to monitor the level of the indicator.
D-dimer
The D-dimer is formed as a result of the partial breakdown of the fibrin fiber. This is one of the leading characteristics of a pregnancy coagulogram. The usual rate is less than 500 ng / ml.
Although for pregnant women, other parameters are also normal. Already at the beginning of pregnancy, the level of the substance begins to increase, and before childbirth it becomes several times higher than normal.
Enhancement note when:
- diabetes mellitus;
- kidney disease;
- complicated pregnancy;
- in old age.
Platelets
Platelets are blood cells that are most directly related to maintaining a normal blood composition. The norm in the blood is from 150,000 to 400,000 per microliter.
With a decrease in concentration, diagnose:
- thrombocytopenia;
- insufficient maternal nutrition.
Platelets are produced in the bone marrow.
DIC syndrome
With deviations in blood coagulability during the period of bearing a child, there is a danger of the appearance of the so-called DIC syndrome, which is manifested by increased coagulability at the initial stage and a decrease in coagulability at the second, that is, it causes intense bleeding.
DIC syndrome is the most dangerous complication in gynecology, most often it is uncontrollable and dangerous not only for the life of the child, but also for the life of the mother.
Another situation is also possible. The blood becomes too fluid due to changes in the anticoagulant system. As a result, the risk of blood loss, especially during childbirth.
In order to establish hemostasis, the analysis and decoding of the coagulogram is carried out. Considering the results of the study, treatment is prescribed.
Ideally, this analysis is done every three months of pregnancy.
An off-schedule is carried out if:
- pregnancy failures have occurred;
- hypertension is diagnosed;
- swelling;
- protein in the urine.
- increased tone of the uterus.
Normally, the coagulation and anticoagulation systems are in equilibrium. If any of the indicators of these systems is displaced, a failure occurs in the system of the entire hemostasis. This is most dangerous for pregnant women.
The most severe complication is disseminated intravascular coagulation. Strengthening the action of the coagulation system promotes the development of disseminated intravascular coagulation. In the course of the development of the disorder, a pregnant woman may have placental abruption, amniotic fluid embolism.
Antiphospholipid syndrome
Signs:
- Thrombophlebitis of the arms, legs;
- Parts of the skin over the affected vessel turn red, become denser, edema appears;
- Poorly healing wounds appear on the skin;
- There is a pattern in the form of a grid on the skin - bluish spots of a strange shape, having branches, light in the center;
- Under pressure, the spots disappear;
- The spots become paler when the woman is hot, and less bright when she is cold;
- On the tips of the fingers, on the feet, there may be spots with a stellate or linear pattern of small vessels.
This is a violation of the immune system. An increase in the number of antibodies to phospholipids occurs in the body. This is a list of signs that are related to venous and arterial thrombosis. Pregnant women with APS may experience miscarriage due to fetaplacental insufficiency.
Using coagulogram indicators, you can control the smallest changes in organism.
In fact, all characteristics depend on both the disorders and the patient's age, the day of the menstrual cycle, the amount and duration of treatment with a particular drug, etc.
Thus, when decoding, doctors do not always have the opportunity to compare the available data with the indicators of the norm. In this case, you need to take into account the smallest features of the human body.
Coagulogram results
The listed analysis indicators are not complete. The selection of the necessary parameters for diagnostics is dictated by various reasons. The test results can be obtained the next day after blood collection.
A surgeon, gynecologist, infectious disease specialist, therapist, ENT, endocrinologist are sent for such an analysis.
Except for pregnant women, doctors advise to undergo an analysis those who have suspicions of the presence of immune lesions, disorders of the heart and blood vessels, or those who suffer from varicose veins of the legs. If the patient has abnormalities in the liver, then he needs a coagulogram.
Only a professional can accurately interpret the analysis indicators. It is he who will carefully consider the available results and draw conclusions about the degree of their deviation from the norm.
