Hemostasiogram coagulogram what. Coagulogram: norm and interpretation of results

Our organism protect numerous mechanisms that ensure homeostasis - the constant constancy of the internal environment of our body. One of the most important of them is the system of hemostasis or coagulation, which prevents blood loss when the integrity of the bloodstream is damaged. In the process of blood clotting and clot formation, there are dozens of reactions that can be influenced by hundreds of different chemicals. And in itself, this system includes a number of other regulatory mechanisms, some of which increase blood clotting, while others lower it.

Due to the great importance of the system hemostasis For the stable functioning of the body, various methods have been developed in clinical medicine to study this protective reaction of the body. The most common analysis for the study of blood clotting is the determination of the coagulogram, which includes determining the time required to stop bleeding and the number of various factors of this system. This study provides a lot of information about the state of the body as a whole, because the normal operation of the hemostasis system depends on the proper functioning of various organs and systems, so any disturbances in their work are reflected in the coagulogram.

There are a number testimony that warrant this study. Firstly, the determination is mandatory before surgical interventions - during operations, the integrity of the bloodstream is significantly violated, which must be eliminated by the hemostasis system. Otherwise, severe complications may develop in the postoperative period. Secondly, this analysis is often prescribed for pregnant women - due to strong hormonal changes, various blood clotting disorders are possible, both in the direction of its decrease and increase. Thirdly, the determination of a coagulogram is desirable in diseases of various organs that are somehow related to the process of blood clotting - first of all, these are the liver, spleen, bone marrow, and the cardiovascular system. Also, autoimmune diseases have their influence on the formation of blood clots. Finally, determining the activity of the blood coagulation system is useful and, in some cases, necessary before prescribing certain drugs - anticoagulants (for example, heparin), acetylsalicylic acid, hormonal contraceptives.

Donating blood for determination activity of the coagulation system requires some preparation. 8-12 hours before the study, you should not take food, alcoholic beverages, coffee or strong tea. Some of the parameters of the coagulogram have a certain instability, especially under stressful conditions for the body, therefore, before and during the test, one should not be nervous or subjected to heavy physical exertion. Immediately before blood sampling, a person is given a glass of clean water to drink - this increases the accuracy of the study. Blood is taken from a vein in the arm and immediately begin to determine the main indicators.

Exists basic and detailed blood test to determine the coagulogram. The norm of the basic coagulogram looks something like this:

Despite such a large number indicators, usually the form of the basic coagulogram contains only the main ones - fibrinogen concentration, clotting time, activated recalcification time (AVR), activated partial thromboplastin time (APTT), prothrombin index, thrombin time, the amount of soluble fibrin-monomeric complexes. Based on these values, one can indirectly determine the activity of a particular factor.

clotting time- one of the basic indicators, which is determined by one of the first. Its value depends on the type of material of the test tube in which the indicator is determined. In a glass container, the formation of a blood clot normally takes from 5 to 7 minutes, while in a silicone tube, the normal clotting time is 12-25 minutes. Due to such a large difference between the two norms of this indicator, depending on the material of the container, it is necessary to specify in the analysis form whether a silicone or non-silicone tube was used for this. The lengthening of this indicator indicates a decrease in the activity of the hemostasis system or an increase in the thrombolytic ability of the blood, and a more rapid formation of a blood clot indicates the opposite phenomenon - an increase in the activity of blood coagulation, or a decrease in the antithrombin system. The causes of these phenomena are determined by other indicators of the coagulogram.

fibrinogen concentration- one of the main proteins of the hemostasis system - is also a key indicator of the coagulogram. It is this soluble protein that, during the formation of a blood clot, turns into strands of insoluble fibrin, which forms a thrombus. The norm of its content is 2-4 g / l of blood plasma, which is a fairly high indicator. It is characteristic that in pregnant women on the eve of childbirth (in the third trimester), there is an increase in the content of fibrinogen up to 6 g / l, which is a normal preparation of the body for bleeding that accompanies the birth of a child. However, you should carefully monitor this indicator - its excessive increase can cause blood clotting right inside the bloodstream, which underlies the onset of DIC, often leading to death. In addition to pregnancy, the level of fibrinogen increases with various inflammatory processes, shocks of various origins, and endocrine disorders.

Decrease in this indicator coagulograms causes increased bleeding and an increase in blood clotting time. The cause of this condition may be some liver diseases (hepatitis, cirrhosis), lack of vitamins (K, C, B) and related diseases of the gastrointestinal tract (dysbacteriosis, Crohn's disease, malabsorption syndrome), taking certain drugs, as well as the second stage of DIC.

Activated Recalcification Time (ART) in a coagulogram, it characterizes how quickly the level of calcium ions (which are involved in the formation of a blood clot) in the blood plasma is restored. The normal phenomenon is the value of this indicator in the range from 1 to 2 minutes (60-120 seconds). An increase in the duration of recalcification indicates a reduced blood coagulation activity, which is a consequence of an insufficient number of platelets in the blood or their functional inferiority, a lack of the main factors of the hemostasis system, an increased activity of the antithrombin system, and also in the second stage of DIC, when there is an exhaustion of the entire blood coagulation system .
Decreasing time recalcification speaks of increased thrombosis - with thrombophlebitis and thrombosis.

Activated partial thromboplastin time (APTT)- characterizes the time it takes for the formation of a blood clot. The norm of this parameter of the coagulogram is 35-45 seconds, but when using some types of reagents, 28-35 seconds can also be considered the norm. The shortening of this time is not a characteristic clinical sign of any disorders, but its significant increase occurs with the use of anticoagulants (heparin), an acquired or congenital deficiency of the main blood coagulation factors (for example, hemophilia), with some autoimmune diseases (systemic lupus erythematosus).

Prothrombin index- the ratio of human plasma time to the reference value. This indicator of the coagulogram is expressed as a percentage and is normally 78-142%. The prothrombin index is the most accurate value that determines the efficiency of the entire hemostasis system. A decrease in this indicator is a sign of low blood clotting, which occurs as a result of a lack of key factors, vitamin K deficiency, diseases of the liver and gastrointestinal tract. An increase in the protombin index indicates a high risk of thrombosis and related disorders - myocardial infarction, stroke, kidney damage, thromboembolism of various vessels.

thrombin time- an indicator closely related to the level of fibrinogen in the blood. Physically, it represents the time during which a certain amount of fibrinogen passes into insoluble fibrin - the norm is from 10 to 20 seconds. With an increase in this time, a decrease in the level of fibrinogen is observed, or this phenomenon is due to the activity of fibrinolytic systems and factors - for example, in liver diseases, pancreatitis. Also, an increase in thrombin time occurs with the use of anticoagulants. A decrease in this indicator of the coagulogram is observed in the last trimester of pregnancy and other factors leading to an increase in the level of fibrinogen in the blood.

The amount of soluble fibrin-monomeric complexes- these proteins are a transitional link between fibrinogen and fibrin. The norm of their content in blood plasma is 3.36-4.0 mg per 100 ml of plasma. An increase in the number of these complexes indicates an increased activity of the hemostasis system. A decrease in this indicator is observed with a general decrease in the activity of the blood coagulation system. This indicator is the first to respond to the use of anticoagulants, therefore it is the most accurate and sensitive method for determining the effectiveness of anticoagulant therapy, which is widely used in clinical practice.

Typically, after analysis an extended study is performed to compile a basic coagulogram, which is used to confirm problems with blood clotting. The purpose of obtaining an extended coagulogram is to more accurately determine the causes of certain blood clotting disorders. As part of the extended analysis, a number of additional indicators are determined.

Protein C is one of the most important anticoagulant factors. Its level is expressed as a percentage of the reference indicator, the norm of determination in the extended coagulogram is 60-140%. With a decrease in this indicator, the blood coagulation system begins to prevail, which leads to increased thrombosis. The reason for the decrease may be liver disease and vitamin K deficiency, which often develops as a result of colon dysbacteriosis. Also, a decrease in the level of protein C may be due to genetic factors.

D-dimer is a product of partial disintegration of a fibrin clot (thrombus), therefore, with increased thrombus formation, the level of this indicator also increases. The content norm - its amount should not exceed 500 ng / l. In pregnant women in the last trimester, due to a general increase in the activity of the hemostasis system, the level of D-dimers may slightly exceed the norm. In other cases, a significant increase in this indicator is a symptom of thrombophlebitis, disorders in decompensated diabetes mellitus, and toxicosis.

Antithrombin-3, as well as protein C, is an anticoagulant factor, the norm of which is from 75 to 110% of the reference value. A sharp decrease in the content of this factor plays a special role, since in such a situation the risk of thrombosis with the development of an embolism or even DIC increases significantly.

Antibodies to phospholipids also called lupus antibodies, are normally completely absent in the blood. Their appearance in plasma is a sign of systemic lupus erythematosus, a severe autoimmune disease. The determination of their content in plasma within the framework of an extended coagulogram is due to the fact that this type of antibody destroys platelets and thereby sharply reduces blood clotting.

Level platelets when determining the coagulogram, it is rarely determined, since often this value is already known from the general blood test. However, the role of platelets, the norm of which is 180-320 billion per liter, in the development of a blood clot is enormous, so it makes no sense to start any research without first determining their number.

Educational video of decoding the coagulogram in normal and abnormal conditions

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What is a coagulogram?

However, it must be understood that the coagulation system stops bleeding and ensures the formation of a blood clot not only with skin wounds, but also with any damage to blood vessels. For example, if the vessel bursts from overstrain or the active course of the inflammatory process in any organ or tissue. Also, the coagulation system stops bleeding after separation of the mucous membrane during menstruation or the placenta after childbirth in women.

Violations of the coagulation system can proceed not only by the type of its insufficient activity, but also by its excess. With insufficient activity of the coagulation system, a person develops bleeding, a tendency to bruising, long-term non-stop bleeding from a small wound on the skin, etc. And with excessive activity of the coagulation system, on the contrary, a large number of blood clots are formed that clog blood vessels and can cause heart attacks, strokes, thrombosis, etc.

Returning to the coagulogram, this analysis can be briefly described as the determination of blood coagulation parameters. Based on the results of the coagulogram, it is possible to identify certain disorders in the blood coagulation system and begin their timely treatment aimed at achieving compensation and preventing bleeding or, on the contrary, excessive blood clots.

Coagulogram indicators

In addition, there are several varieties of the so-called standard coagulograms, which include only some of the specific parameters necessary for the analysis of coagulability in typical situations. Such coagulograms are done under certain conditions, for example, during pregnancy, before surgery, after the use of drugs that affect blood clotting. If any indicators of such typical coagulograms turn out to be abnormal, then to find out at what stage of blood coagulation a violation occurred, other necessary parameters are determined.

Each indicator of the coagulogram reflects the course of the first, second or third stage of blood coagulation. At the first stage, spasm of the blood vessel occurs, that is, it narrows as much as possible, which minimizes the amount of damage. At the second stage, "gluing" (aggregation) of blood platelets occurs among themselves and the formation of a loose and large clot that closes up the hole in the blood vessel. At the third stage, a kind of network is formed from the threads of a dense fibrin protein, which cover the loose mass of adherent platelets and tightly fix it to the edges of the hole on the vessel wall. Then the mass of adherent platelets thickens and fills the cells between the fibrin fibers, forming a single elastic and very strong "patch" (thrombus), which completely closes the hole in the wall of the blood vessel. This is where blood clotting ends.

Let's consider all the indicators that are part of the coagulogram and reflect all three stages of blood coagulation, and also give examples of standard hemostasiograms for various typical conditions.

So, the indicators of the coagulogram, reflecting the three different stages of blood coagulation, are the following:

1. First stage indicators prothrombinase formation):

• Blood clotting time according to Lee-White;
• Contact activation index;
• Plasma recalcification time (PRT);
• Activated recalcification time (ART);
• Activated partial thromboplastin time (APTT, APTT, ARTT);
• consumption of prothrombin;
• Factor VIII activity;
• Factor IX activity;
• Factor X activity;
• Factor XI activity;
• Factor XII activity.

• prothrombin time;
• International Normalized Ratio - INR;
• Prothrombin in% according to Duke;
• Prothrombin index (PTI);
• Factor II activity;
• Factor V activity;
• Factor VII activity.

• thrombin time;
• fibrinogen concentration;
• Concentration of soluble fibrin-monomer complexes.

In addition to these indicators, in the analysis called "coagulogram" laboratories and doctors often include other indicators that reflect the functioning of another system, which is called anticoagulant (fibrinolytic). Anticoagulant system It has the opposite coagulation effect, that is, it dissolves blood clots and inhibits the process of blood coagulation. Normally, these systems are in dynamic balance, leveling the effects of each other and ensuring blood clotting when necessary, and the dissolution of a clot if it was formed by accident.

The most characteristic example of the work of the anticoagulant system is the following: after damage to the vessel, the coagulation system formed a thrombus, which closed the hole and stopped the flow of blood. Then the vessel wall recovered, its tissues grew and completely closed the existing hole, as a result of which the thrombus was simply glued to the already intact wall of the blood vessel. In this state, a thrombus is not needed, moreover, it has a negative effect, since it narrows the lumen of the vessel and slows down the flow of blood. This means that such a thrombus must be removed. It is at such moments that the anticoagulant system plays a huge role, since it is activated when unnecessary blood clots are detected that must be removed. As a result of the work of the anticoagulant system, the thrombus is sort of disassembled into parts, which are then removed from the body. That is, the anticoagulant system dismantles blood clots that have already become unnecessary, cleaning the walls of blood vessels and freeing their lumen from a useless cluttering clot that has fulfilled its function.

In addition, it is the anticoagulant system (specifically, antithrombin III) that stops the active work of the coagulation system when the thrombus has already been created. That is, when a thrombus closes a hole in the vessel wall, the anticoagulant system turns on, which inhibits the activity of the coagulation system so that it, in turn, does not create too large "patches" that can completely block the vessel lumen and stop the movement of blood in it.

The work of the fibrinolytic system is evaluated by the following indicators, which include in the coagulogram:

• Lupus anticoagulant;
• D-dimers;
• Protein C;
• Protein S;
• Antithrombin III.

Depending on which parameters are included in the analysis, there are currently two main types of coagulograms that are used in everyday clinical practice - these are extended and screening (standard). The standard coagulogram includes the following indicators:

• fibrinogen;
• Thrombin time (TV).

The extended coagulogram includes the following indicators:

• Prothrombin in% according to Quick or prothrombin index;
• International Normalized Ratio (INR);
• fibrinogen;
• Activated partial thromboplastin time (APTT);
• Thrombin time (TV);
• Antithrombin III;
• D-dimer.

As a rule, the arrangement of indicators in such coagulograms is arbitrary, depending on which parameters the doctor considers necessary for his work. In many cases, such "standard" and "extended" coagulograms include C-protein, S-protein and others, which need to be determined only in rare cases when a person has clotting disorders and it is necessary to establish exactly what is not working. In other cases, coagulograms include indicators such as ethyl test and clot retraction, which are outdated and are not currently used to diagnose the coagulation system. These indicators are included in the composition of coagulograms simply because the laboratory performs them.

In fact, such independently compiled "standard" and "extended" coagulograms are very free variations on generally accepted world standards, and therefore are always associated with excessive prescription of tests and waste of reagents.

What coagulogram parameters do children and pregnant women need?

Coagulogram parameters and their values ​​are normal

Deciphering the coagulogram

Lee-White clotting time

Plasma recalcification time (PRT)

Activated Recalcification Time (ART)

If the AVR or GRP is below normal, then this indicates a tendency to thrombosis. If the ABP or GRP is higher than normal, then this indicates the danger of severe bleeding even with minor damage to the integrity of the tissues. Usually, prolongation of ABP or VRP occurs due to low blood platelet counts, heparin administration, as well as against burns, trauma, and shock.

Activated partial thromboplastin time (APTT, APTT, ARTT)

Prolongation of APTT is characteristic of the following diseases:

• von Willebrand disease;
• Coagulation factor deficiency (II, V, VII, VIII, IX, X, XI, XII);
• Congenital deficiency of prekalikrein and kinin;
• The introduction of heparin or streptokinase;
• Taking anticoagulants (Warfarin, Sincumarin, etc.);
• Vitamin K deficiency;
• Low levels of fibrinogen in the blood;
• Liver diseases;
• II and III phases of DIC;
• Condition after transfusion of a large volume of blood;
• The presence of lupus anticoagulant in the blood;
• antiphospholipid syndrome;
• Chronic glomerulonephritis;
• Systemic lupus erythematosus;
• Connective tissue diseases.

• Acute blood loss;
• The initial stage of DIC.

Activity of all coagulation factors (II, V, VII, VIII, IX, X, XI, XII)

Prothrombin time (PT, RT, recombipl RT)

Thus, prothrombin time reflects a very important physiological phenomenon - the rate of activation of the internal pathway of blood coagulation, which is responsible for the formation of blood clots and the "patching" of holes in the vessels formed due to the negative effects of substances circulating in the blood.

Prolongation of prothrombin time more than normal indicates the following diseases:

• Taking anticoagulants (Warfarin, Thromboass, etc.);
• The introduction of heparin;
• Congenital or acquired deficiency of coagulation factors II, V, VII, X;
• Vitamin K deficiency;
• DIC in the initial phase;
• Hemorrhagic diathesis in newborns;
• Liver disease;
• Narrowing of the bile ducts;
• Violation of absorption and digestion of fats in the intestine (sprue, celiac disease, diarrhea);
• Zollinger-Ellison syndrome;
• Fibrinogen deficiency in the blood.

• Incorrect blood sampling through the central catheter;
• High or low hematocrit;
• Long-term storage of blood plasma in the refrigerator at + 4 o C;
• Increased concentration of antithrombin III;
• Pregnancy;
• DIC;
• Activation of the anticoagulant system.

Prothrombin index (PTI)

International Normalized Ratio (INR)

An increase in INR above the norm occurs under the same conditions as the prolongation of prothrombin time. A decrease in INR below normal occurs under the same conditions as a shortening of the prothrombin time.

Duke's prothrombin

An increase in the percentage of prothrombin according to Duke above the norm occurs under the same conditions as the shortening of the prothrombin time. A decrease in the percentage of prothrombin according to Duke below the norm occurs under the same conditions as the prolongation of the prothrombin time.

Thus, prothrombin time, prothrombin index, international normalized ratio and Duke prothrombin are parameters reflecting the same physiological action, namely, the rate of activation of the internal pathway of blood coagulation. These parameters differ from each other only in the way they are expressed and calculated, and therefore are completely interchangeable.

However, it has traditionally developed so that in some situations it is customary to evaluate the rate of activation of the internal blood coagulation pathway by PTI, in others by INR, and in others by Duke, and in fourth by prothrombin time. Moreover, PTI and prothrombin according to Duke in% are almost always mutually exclusive, that is, the laboratory determines either the first or second parameter. And if there is PTI in the results of the analysis, then Duke prothrombin can be omitted and, accordingly, vice versa.

PTI and prothrombin according to Duke are calculated in diagnostic coagulograms that people take before surgery, during preventive examinations or examinations for any symptoms. INR is calculated during the control and selection of the dosage of anticoagulants (Aspirin, Warfarin, Thrombostop, etc.). Prothrombin time, as a rule, is indicated in coagulograms necessary to detect diseases of the blood coagulation system.

Thrombin Time (TV, TT)

The prolongation of thrombin time reflects a decrease in blood clotting and is observed in the following conditions:

• Fibrinogen deficiency of varying severity;
• DIC;
• Multiple myeloma;
• severe liver disease;
• Uremia (increased concentration of urea in the blood);
• The presence in the blood of fibrin or fibrinogen breakdown products (D-dimers, RFMK).

• The use of heparin;
• The first stage of DIC.

Fibrinogen concentration (fibrinogen, Fib)

• myocardial infarction;
• Injuries;
• burns;
• nephrotic syndrome;
• multiple myeloma;
• Inflammatory diseases that occur for a long time;
• Pregnancy;
• Taking estrogen-containing oral contraceptives (Marvelon, Mercilon, Qlaira, etc.);
• Condition after surgery.

• DIC;
• Metastasis of malignant tumors;
• Acute promyelocytic leukemia;
• Postpartum complications;
• Hepatocellular insufficiency;
• Infectious mononucleosis ;
• Toxicosis of pregnancy;
• Poisoning with poisons;
• Taking thrombolytic drugs that dissolve blood clots;
• Anchor therapy;
• Congenital fibrinogen deficiency;
• Age less than 6 months.

Soluble fibrin-monomeric complexes (SFMK)

Lupus anticoagulant

D-dimers

An increase in the level of D-dimers in the blood develops with the following diseases:

• DIC syndrome (first phase);
• myocardial infarction;
• Thrombosis of arteries or veins;
• Infectious diseases;
• Acute or chronic inflammatory diseases;
• Preeclampsia during pregnancy;
• Large hematomas;
• The presence of rheumatoid factor in the blood;
• Condition after surgical operations;
• Age over 80;
• Malignant tumors of any localization;
• The use of tissue plasminogen activator.

Protein C

• Congenital deficiency of protein C;
• Liver disease;
• The first stage of the development of DIC.

Antithrombin III

An increase in the concentration of antithrombin III in the blood develops under the following conditions:

• Acute hepatitis;
• cholestasis;
• Vitamin K deficiency;
• Acute pancreatitis;
• period of menstruation;
• taking warfarin;
• Taking anabolic steroids;
• Long-term or severe inflammatory processes;
• Condition after kidney transplantation;
• Elevated levels of bilirubin in the blood (hyperbilirubinemia);
• Taking drugs that increase blood clotting.

• Congenital deficiency of antithrombin III;
• Condition after liver transplant;
• Cirrhosis of the liver;
• Liver failure;
• Deep vein thrombosis;
• DIC;
• myocardial infarction;
• pulmonary embolism;
• Severe inflammatory diseases of any organs and systems;
• The use of heparin in high dosages without monitoring blood coagulation;
• The use of L-asparaginase for the treatment of gestosis of pregnancy;
• Third trimester of pregnancy (27 - 40 weeks of gestation inclusive);
• Taking oral contraceptives.

Protein S

Deciphering the coagulogram during pregnancy

In connection with such an increase in the volume of circulating blood, the content of various substances of the coagulation and anticoagulation system also increases in a pregnant woman. After all, the body of a woman must provide the substances necessary for the functioning of the coagulation and anticoagulation systems, both for herself and the fetus. And that is why during pregnancy there is always an increase in the content of all components of the coagulation and anticoagulation systems, and at the same time an increase in their activity. This, in turn, means that the activity and content of all coagulogram parameters are increased by 15 - 30%, which is the norm for pregnancy.

In practice, this means that the norms of the coagulogram of a pregnant woman differ significantly from those for other adults. So, normal values ​​​​of the following parameters during pregnancy are less or more than usual by 15 - 30%:

• Blood clotting time according to Lee-White - 8 - 10 seconds in a silicone tube and 3.5 - 5 seconds in a glass tube;
• Plasma recalcification time - 45 - 90 seconds;
• Activated recalcification time - 35 - 60 seconds;
• Activated partial (partial) thromboplastin time - 17 - 21 seconds for Renam reagents and 22 - 36 seconds for "Technology-Standard" kits;
• International normalized ratio (INR) - 0.65 - 1.1;
• Prothrombin time - 9 - 12 seconds;
• Prothrombin in% according to Duke - 80 - 150%;
• Prothrombin index - 0.7 - 1.1;
• Thrombin time - 12 - 25 seconds;
• Fibrinogen concentration - 3 - 6 g / l;
• Soluble fibrin-monomeric complexes – up to 10 mg/100 ml;
• Lupus anticoagulant - absent;
• D-dimers - I trimester of pregnancy - up to 1.1 mg / l; II trimester of pregnancy - up to 2.1 mg / l; III trimester of pregnancy - up to 2.81 mg / l;
• Protein C - 85 - 170% or 3.1 - 7.1 mg / l;
• Protein S-80 - 165;
• Antithrombin III - 85 - 150%.

However, the analysis indicators do not always fit into the norm, and in this case, women want to understand what this means, that is, to decipher the coagulogram. In general, in order to decipher the coagulogram during pregnancy, you need to know what this analysis is for and what processes it reflects in a woman's body. After all, a coagulogram during pregnancy is not done to identify diseases of any organs and systems, but to assess the risk of thrombosis or, on the contrary, bleeding, which can be fatal for the fetus and the woman herself, provoking placental abruption or heart attacks, miscarriages, intrauterine fetal death, gestosis etc.

Therefore, in fact, a coagulogram during pregnancy is prescribed for early detection of the threat of placental abruption, preeclampsia, antiphospholipid syndrome, latent DIC and thrombosis. The coagulogram does not carry any more functions. These pathologies must be identified at an early stage and the necessary therapy carried out, since in the absence of such they can lead, at best, to loss of pregnancy, and at worst, to the death of the woman herself.

So, if a pregnant woman has a hidden threat of placental abruption, gestosis, DIC or thrombosis, then the coagulogram indicators will vary within the following limits:

• Decreased antithrombin III to 65% or less due to excess consumption;
• An increase in the concentration of D-dimers above the norm for the duration of pregnancy;
• An increase in the concentration of RFMK by more than 4 times relative to the norm (above 15 mg / l);
• Shortening of thrombin time less than 11 seconds (first phase of DIC);
• Elongation of thrombin time for more than 26 seconds (an extended phase of DIC, which requires urgent medical intervention);
• Reducing the amount of fibrinogen below 3 g / l;
• Prolongation of prothrombin time, increase in PTI and INR (initial stage of DIC);
• The decrease in the amount of prothrombin according to Duke is less than 70% (the initial stage of DIC);
• Prolongation of APTT more than normal;
• Presence of lupus anticoagulant.

1) PLATELETS:

The number of platelets is measured in thousands per 1 microliter of blood. For men, 200-400 thousand U / μl is considered the norm, and for women - 180-320 thousand U / μl. During menstruation, the level can drop to 75-220 thousand U / μl - this is normal. The indicator also decreases during pregnancy - to approximately 100–310 thousand U / μl.

2) APTT:

Why determine the APTT?

⦁ diagnosis of the causes of bleeding and a tendency to form blood clots

⦁assessment of the correctness of treatment with anticoagulants

Reasons for an increase in APTT:

Elevated aPTT results indicate an increased risk of bleeding as a result of congenital or acquired deficiency of one or more coagulation factors.

Tests to monitor anticoagulant treatment:

Laboratory monitoring of heparin use is carried out by monitoring the APTT (activated partial thromboplastin time). This test is one of the main tests for monitoring heparin treatment. In patients receiving heparin therapy, APTT is prolonged by 1.5–2.5 times, which indicates the effectiveness of treatment.

The determination of APTT allows you to finally resolve the issue of tolerance to heparin: for this, the APTT is determined 1 hour before the next administration of heparin. If the APTT is prolonged by more than 2.5 times compared to the norm, an increased sensitivity to heparin is noted, its dose is reduced or the interval between injections is increased.

APTT norms in the blood:

The APTT norm for adults is 28-40 seconds.

Normally 0.8-1.2, with heparin treatment - 2-4.

Remember that each laboratory, or rather, laboratory equipment and reagents, has “its own” standards. In the laboratory test form, they go in the column - reference values ​​\u200b\u200band the norm.

The result of APTT within the normal range indicates the normal function of blood coagulation along the internal and common pathways, but does not exclude a moderate deficiency of one of the coagulation factors and the presence of lupus anticoagulant. APTT will change only with a 30-40% deficiency of one of the blood coagulation factors.

3) PROTHROMBIN TIME AND ITS INDICATORS:

Prothrombin time is a special laboratory indicator that reflects the external pathway of activation of the blood coagulation system.
Often, prothrombin time is determined with activated partial thromboplastin time (APTT), which evaluates the intrinsic pathway of activation. Together, these two indicators reflect the systems of the coagulation and anticoagulation systems as a whole and its changes in the pathology of internal organs. The norm of prothrombin time is 11-16 seconds.

Also, to determine the functions of the coagulation system, indicators are also determined - the prothrombin index and the international normalized ratio (INR).

Prothrombin index (PTI)- indicator in percent, determined by the ratio of the prothrombin time of the control plasma to the PTT of the studied human plasma. Normally, it should be 95-105%.

International Normalized Ratio (INR)- in this study, blood taken from a patient is compared with plasma normalized according to the international standard. The value of the norm can range from 0.85-1.25.

Reduction of prothrombin time is a rare phenomenon. It has no diagnostic value, but signals an increased tendency to form blood clots.

Prothrombin time during pregnancy:
Analysis of the change in prothrombin time during pregnancy is one of the important diagnostic methods used in biochemical screening. Particular attention should be paid to this particular group of patients. Indications for periodic monitoring of prothrombin time in expectant mothers are:

1. A history of miscarriages, spontaneous abortions, missed pregnancies.

2. Hypertonicity of the uterus and other threatening conditions.

3. The presence of signs of preeclampsia in a pregnant woman at all stages of pregnancy.

The norm of prothrombin time during pregnancy is 11-18 s. If the PTT is elevated, then possible bleeding in the birth and postpartum periods should be assumed. If the prothrombin time is lowered, then it is necessary to be wary of the development of DIC.

4) THROMBIN TIME:

Thrombin time depends on the level of fibrinogen in the blood: a decrease in the level of fibrinogen increases the thrombin time and for this reason, the analysis of thrombin time is usually combined with the analysis of fibrinogen, as well as other indicators of the coagulogram.

Thrombin time - the norm is 15-18 seconds. However, in various diseases, the thrombin time indicator goes beyond the normal range - thrombin time is increased or decreased.

Thrombin time is increased - indicates a tendency to hypocoagulation.

Thrombin time is increased with:

Treatment with fibrinolytics, heparin;

A significant decrease in the fibrinogen index in the blood plasma (with functional disorders in the liver);

Excess physiological anticoagulants;

Some blood diseases;

The second stage of the syndrome is DIC (impaired blood coagulation processes in critical conditions: severe injuries, shock, burns, massive thrombosis.

The shortening of thrombin time indicates the risk of thrombosis, and also occurs in conditions accompanied by an increase in the content of fibrinogen in the blood and in the first stage of DIC.

If the thrombin time is changed during the analysis, this indicates pathologies not only in the circulatory system, but in other organs. If the thrombin time in the coagulogram is increased, it means that the hematopoietic system has failed, which can lead to thrombosis. This disease is called hyperfibrinogenemia. If the study revealed a time below the norm (hypofbrinogenemia), then in case of injuries of blood vessels or organs, this can lead to prolonged bleeding. Diseases can be both acquired and hereditary.

5) FIBRINOGEN:

One of the important characteristics of blood is the study of its coagulation abilities. Among the main indicators of the coagulogram, the rate of fibrinogen in the blood is very relevant. A description of this substance, its role in the body, as well as the main pathological processes in which it can participate.

Norms:

- Adults 2-4 g/l;

- Pregnant women no more than 6g/l;

Causes and dangers of increasing the indicator:

During pregnancy in women, the content of fibrinogen is higher than in other categories of adults. This is the only physiological condition that does not require any correction. But even for him, a norm has been established, the excess of which should be regarded as a pathology. The danger of conditions in which elevated fibrinogen is recorded lies in the fact that there is a high risk of increased blood clotting in the vessels. This causes the formation of blood clots and disruption of microcirculatory processes. As a result, damage to internal organs, the heart and brain in the form of a heart attack, stroke or gangrene.

How can you help:

The need to lower fibrinogen mainly occurs in difficult situations. Most cases of examination of persons with chronic vascular pathology, which constitute the main risk group for increased blood clotting, show fibrinogen values ​​that correspond to the norms. All therapeutic measures are determined by the reason for the increase in this indicator and the real threats of such a condition.

Fibrinolytics - alteplase, pharmacokinase. Before using them, the patient must be carefully examined, since drugs of this series cause a large number of complications. Therefore, they are prescribed mainly in critical situations and only in a medical institution;

Antiplatelet agents. Acetylsalicylic acid preparations (, aspekard, lospirin) and clopidogrel. They help not only to reduce fibrinogen, but to block the start of increased coagulability against the background of its increase;

Diet low in animal fats and cholesterol;

Reception of vitamin preparations and trace elements (vitamin E, omega-3, vitamins A, C, nicotinic acid). With long-term use, they are able to effectively correct the fibrinogen index;

Medicinal plants and green tea;

Dosed physical activity, excluding hypodynamia and muscle strain.

An increase in fibrinogen accompanies burns, surgical interventions, taking estrogens and oral contraceptives.

If the blood coagulogram shows a significant decrease in the index, this may be a sign of the following pathologies:

⦁ violation of hemostasis;

⦁ severe liver damage;

⦁ toxicosis during childbearing;

⦁hypovitaminosis in group B and deficiency of ascorbic acid.

The level falls during therapy with anticoagulants and anabolics, as well as against the background of the consumption of fish oil.

Fibrinogen B is not normally detected.

6) RFMK:

What does the abbreviation RFMK mean in a hemostasiogram (coagulogram)?

Everything is very simply deciphered: soluble fibrin-monomeric complexes. However, many people who lived their lives never knew or heard about them. And all because the determination of the amount of soluble fibrin-monomer complexes or RFMK, although considered an important laboratory test characterizing the state of the hemostasis system, is not included in the analyzes of every day. As a rule, the coagulogram is limited to such indicators as fibrinogen, APTT, PTI, INR and others, but some parameters, such as D-dimer, RFMK, lupus anticoagulant, etc., are prescribed as needed and are considered additional studies of blood coagulation abilities.
The test for RFMK is recognized as an important marker of thrombinemia - the appearance in the vascular bed of a significant number of small "thrombics", which is very typical for disseminated intravascular coagulation (DIC).

The norm of soluble fibrin-monomer complexes does not have a large difference and is 3.38 + 0.02 mg / 100 ml, while the concentration of RFMK should not cross the upper limit of 4.0 mg / 100 ml (according to individual sources).

RFMC is of great importance during pregnancy, where this study is highly desirable for every expectant mother, because thrombosis and disseminated intravascular coagulation are among the main complications that pose a serious threat to the life of a woman and her unborn child.

The emergence of a new circle of blood circulation that provides nutrition to the placenta and the developing fetus, of course, causes a reaction in the hemocoagulation system, which now not only has to work in the new and constantly changing conditions of a growing pregnancy, but also prepare to successfully cope with childbirth and “bring itself into order" after them. Blood changes its parameters (viscosity, number of platelets - platelets, fibrinogen level, etc.). Naturally, this affects such coagulogram parameters as RFMK, D-dimer, etc. RFMK norms during pregnancy will be higher, but once again I would like to recall the reference values ​​​​of the laboratory that performed the study, with which you need to compare the results of your own analysis. Let's say the norm before pregnancy for this laboratory is determined to 5.0 mg / 100 ml.

In this case, the trimester norm will look like this:

In the first trimester, the hemostasis system has not yet “noted” any special changes, namely, the beginning of the formation of the placenta, therefore, it behaves calmly, that is, without changing its parameters - the amount of RFMK during this period normally does not exceed 5.5 mg / 100 ml;

In the second trimester, when the placenta has already formed (by week 16) and, in order to function normally, began to require a full blood supply, the concentration of soluble fibrin-monomer complexes increases to 6.5 mg / 100 ml;

In the third trimester, the placenta is already beginning to age and prepare to leave the woman’s body, the hemostasis system “feels” the impending blood loss and turns on protective mechanisms in full force - the quantitative content of RFMK increases to 7.5 mg / 100 ml, which is considered the norm for this period. Deciphering the analysis - the doctor's business, however, a pregnant woman should not be on the sidelines and know what to do when the RFMK is elevated.

What threatens the increased level of RFMK during pregnancy?

We do not intend to intimidate the expectant mother, but we want to remind you that a significantly increased result is due to by no means harmless reasons.

It can be:

-Thrombophilia, which, as a rule, is hereditary in nature and manifests itself especially aggressively during pregnancy. This pathology, creating a high risk of clots, prevents the normal course of the gestation process (miscarriages). The task of the gynecologist in this case is to carefully consider a plan of therapeutic measures that create conditions for carrying the fetus up to 7 months (35 - 36 weeks), when the baby, although weak, is quite viable;

-Thrombosis in history during pregnancy, they can re-assert themselves, so this condition is referred to as an indication for a more frequent study of soluble fibrin-monomer complexes;

-Syndrome of disseminated intravascular coagulation, which can cause a variety of causes (infections, shock conditions, injuries, autoimmune diseases, neoplasms, late toxicosis, purulent inflammation, cardiovascular and other chronic pathologies), during childbirth can become an uncontrollable process with a very sad end.

The risk of developing DIC makes it necessary to control the level of RFMK very often, what the expectant mother should understand and clearly follow the doctor's prescriptions in order to save the life of herself and her child.

Please note: RFMK is a marker that allows you to take timely measures to prevent the development of DIC!!!

7) FIBRINOLYTIC ACTIVITY:

Fibrinolytic activity is an indicator of the coagulogram, reflecting the ability of the patient's blood to dissolve the formed blood clots. The component of the anticoagulant system of the body is responsible for this function. With its high concentration, the rate of dissolution of blood clots increases, respectively, bleeding increases.

8) PTI:
PTI (prothrombin index) reflects the ratio of the duration of blood clotting in the norm to the clotting time in the subject.

Reference values ​​(variants of the norm) - from 97 to 100%.

In pregnant women, the indicator increases (up to 150% and above), which is not a pathology.

PTI numbers allow you to identify the presence or absence of liver pathologies. The index rises while taking hormonal contraceptives. An increase in values ​​relative to the norm indicates the risk of developing thrombosis, and a decrease indicates the likelihood of bleeding.

9) THROMBOTEST allows you to visually determine the volume of fibrinogen in the test material. The norm is a thrombotest of 4-5 degrees.

10) PLASMA TOLERANCE TO HEPARIN is a characteristic that reflects the time of formation of a fibrin clot after the addition of heparin to the test material. Reference value - 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 pathologies or the presence of malignant neoplasms can be suspected. Hypercoagulability is typical for late pregnancy (III trimester) and conditions after surgical interventions.

11) D DIMER:

In a healthy person, the level of d-dimer is approximately constant and does not exceed 500 ng/ml in the blood. Its definition is usually included in an analysis called a coagulogram.

D-dimer began to be determined relatively recently. The determination of d-dimer in blood is widely used in the emergency department. When a patient is admitted in a serious condition with suspected thromboembolism, this analysis helps to quickly determine whether there is a thrombosis in the body.

An analysis consisting of two indicators is often prescribed: RFMK and d-dimer. If both RFMK and d-dimer are elevated, it is considered that there is a high probability of thrombus formation in the vessels.
During pregnancy, the level of d-dimer can increase several times, this is not considered a pathology. During pregnancy, the activity of the coagulation system is increased, which is displayed by the analysis. However, very high levels of d-dimer during pregnancy require increased attention and treatment.

This usually indicates the onset of preeclampsia or preeclampsia, complications of pregnancy. Increased levels of d-dimer by more than 5-6 times are also found in pregnant women with kidney disease or diabetes.
A significant increase in d-dimer is possible in the case of a severe pathology called disseminated intravascular coagulation syndrome. At the same time, a huge number of microscopic blood clots form in all vessels, which clog all the small vessels in the body. The disease is characterized by high mortality.

D-dimer in pregnant women:
Under the influence of estrogens, as you now know, the hemostasis system during pregnancy is on alert. This is displayed in the analyzes: increased fibrinogen, prothrombin, antithrombin, d-dimer, RFMK. Shortened blood clotting time (VSK), APTT, INR.

This is explained simply: since the hemostasis system is activated and eager to fight, the processes of fibrinolysis also increase. During pregnancy, the coagulation system, despite the indicators, is in a state of balance.
A number of studies have shown that the use of oral contraceptives causes a much greater risk of thrombosis than normal pregnancy.

D-dimer in the 3rd trimester can be several times higher than before pregnancy. And this is the norm. You do not need to regularly test for d-dimer in the third trimester if you do not have diseases of the hemostasis system - for example, thrombophilia or varicose veins of the lower extremities, often complicated by thrombosis.
If you are healthy, the d-dimer test does not matter to you. And even more so, there is no need to try to reduce its performance with the help of anticoagulants. Some doctors unreasonably prescribe regular tests for d-dimer; fraxiparine , clexane or heparin daily.

Moreover, such therapy may increase the risk of placental abruption, bleeding in the postpartum period. Some studies in this area indicate an increase in d-dimer levels when prescribing direct-acting anticoagulants (heparin, fraxiparin, clexane), since they enhance the processes of fibrin breakdown.

The norm of D-dimer during pregnancy varies significantly depending on the period:

-First trimester. The amount increases one and a half times compared to the amount before conception (on average, it should not exceed 750 ng / ml);
-Second trimester. Indicators increase twice (do not exceed 1000 ng / ml);

-Third trimester. The amount increases three times (no more than 1500 ng / ml).

P.S. Reference values ​​of individual indicators of blood coaulogram in pregnant women:

⦁ thrombin time - 11-18 sec.;

⦁APTT - 17-20 sec.;

⦁fibrinogen – 6 g/l;

⦁prothrombin - 78-142%.

Important: a deviation in the level of prothrombin from normal levels may indicate placental abruption!

In the first trimester, the clotting time, as a rule, increases significantly, and in the third trimester it is significantly shortened, thereby providing a woman with protection from possible blood loss during delivery.

A blood coagulogram allows you to identify the threat of spontaneous abortion or premature birth due to the formation of blood clots. Violations of the coagulation system of a pregnant woman negatively affects the central nervous system of the unborn child.

Important: the availability 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 disease (in particular, varicose veins) or liver failure is diagnosed.

The coagulogram of the blood is also examined with a decrease in immunity and a negative Rh factor.

Table of norms of coaulogram during pregnancy:

Coagulogram (hemostasiogram, blood clotting test, blood clotting assessment)- this is an analysis that allows you to judge the main indicators of the coagulation and anticoagulation systems of the blood.

The mechanism of blood coagulation is very complex and depends on many factors. On the one hand, with any injury, the blood at the site of the lesion should quickly clot, forming a thrombus (blood clot), which prevents blood loss and protects the wound from mechanical particles and infection, “glues” the edges of the wound. On the other hand, even with massive injuries, blood must retain its liquid properties inside the vessels, penetrating into the smallest capillaries and not clogging them. To maintain the complex mechanism of hemostasis (stop bleeding), two opposite systems function simultaneously in the body: one system thins the blood, the other folds. Normally, a balance must be maintained between these two processes. The coagulogram allows you to reflect the state of these processes using graphs or numbers.

For analysis, blood is taken from a vein, placed in a test tube with a special additive that does not allow blood to clot, and a number of basic and auxiliary parameters are determined.

The main parameters of the coagulogram

• Prothrombin time (PTT), prothrombin index (PTI) or international normalized ratio (INR). These indicators characterize the external pathway of blood coagulation. Depending on the equipment of the laboratory, one of the tests is performed. The INR indicator is considered the most universal. The data of this test can be compared with each other regardless of the laboratory where it was performed.
• Activated partial thrombin time (APTT) characterizes the internal pathway of hemostasis.
• Thrombin Time (TV)- a test that characterizes the last stage of the formation of a blood clot, indicates the amount of fibrin in the blood.
• fibrinogen- a soluble protein that, when activated by thrombin, turns into insoluble fibrin and forms a blood clot. Fibrin is also an indicator of inflammation.

Additional coagulogram tests

• Antithrombin III- factor of the anticoagulant system. With its deficiency, thrombosis of internal organs, varicose veins, etc. is observed.
• D-dimer- a product of the natural destruction of a blood clot. The determination of D-dimer is necessary for the early diagnosis of thrombosis and the prevention of thromboembolism of the pulmonary artery and other vessels.
• Protein C- factor of the anticoagulant system. With its deficiency, the risk of internal thrombosis increases after surgery, during pregnancy, and so on.
• Lupus anticoagulant (LA) determined with suspicion of the development of antiphospholipid syndrome.

Coagulogram: grounds for appointment

• identifying the causes of thrombosis or bleeding;
• DIC;
• diagnosis of thromboembolism;
• diagnosis of hemophilia;
• auxiliary diagnostics of autoimmune diseases (antiphospholipid syndrome);
• monitoring the effectiveness of treatment with heparin and other drugs that affect hemostasis;
• before and after surgery, some diagnostic and therapeutic procedures (for example, thrombolysis, coronary angiography).

Preparing for a blood coagulation assessment

The analysis is taken in the morning on an empty stomach (the hungry interval should be 8-12 hours), you can drink clean water. It is advisable to stop smoking a few hours before the examination. When conducting an analysis, you must indicate which drugs you have been taking lately.

Normal values ​​of the main indicators of the coagulogram

• PTV 11-16 sec.;
• PTI 80-120%;
• INR 0.8-1.2 units;
• APTT 21-35 sec.;
• TV 14-21 sec.;
• fibrinogen in adults 2-4 g/l;
• fibrinogen in newborns 1.25-3.00 g / l.

Interpretation of coagulogram results

Evaluation of the coagulogram is a complex diagnostic process. Often, for this, they resort to the help of hematologists. Not each indicator is evaluated separately, but their complex, mutual influence on each other and the effect of the therapy.

Against the background of taking drugs that affect blood clotting (heparin, warfarin, and others), the coagulogram parameters change significantly, which is the target of treatment. So, while taking warfarin, the INR level in many diseases should be at the level of 2-3 U, and sometimes increase to 4.5 U, which indicates a decrease in the risk of thrombosis.

Coagulogram parameters can vary significantly depending on the properties of the reagents used by diagnostic laboratories. Therefore, it is desirable to take tests for control within the same institution.

Features of the coagulogram in pregnant women

With various pathologies during pregnancy, as well as with a normal pregnancy before childbirth, a woman is shown to make a coagulogram. Blood counts during pregnancy change significantly. In the first trimester of pregnancy, the blood clotting time may be somewhat longer than normal, and closer to childbirth, on the contrary, the balance shifts in favor of the coagulation system. This is necessary for timely hemostasis after childbirth: this is how the body has adapted to deal with blood loss.

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Such an analysis as coagulogram quite widely known, but it is not prescribed during a standard medical examination. Therefore, patients are sometimes surprised by the doctor's suggestion to conduct this study. More often, a blood coagulogram is performed in patients with a pathology of the cardiovascular system, as well as before a planned operation or in pregnant women. In the latter case, it is done in every trimester without fail.

What is hidden under the mysterious term? Coagulogram (another name for the study - hemostasiogram) is performed to study the patient's blood clotting. Analysis happens basic and extended. Usually, a baseline study is assigned first. It helps to understand where the deviation from the norm occurred in the system. And if a pathology is detected, a detailed study is carried out, as a result of which not only qualitative changes are determined, but also quantitative ones.

The main indications for analysis

• Planned operations. There is always some risk of bleeding during surgery. Therefore, knowledge about the state of the blood coagulation system is important.
• Pregnancy. During this period, changes can occur in the female body, both positive and negative. It is usually done once a trimester. If fetoplacental insufficiency is diagnosed or more often.
• Vascular disorders (increased thrombosis,).
• Diseases of the liver.
• Autoimmune pathologies.
• Violation .
• Cardiovascular pathology (,).
• When prescribing anticoagulants.
• For the correct selection of the dose of acetylsalicylic acid and preparations based on it.
• Prescribing contraceptives. In this case, the analysis is done every 3 months.
• . A coagulogram is carried out to prevent hemorrhages.

Natural system of hemostasis

In a healthy body, a normally functioning system hemostasis- natural protection against excessive blood loss in violation of the integrity of the vascular wall. Many people know about the danger to human health and life, but nature does not create anything in vain: thrombus formation is the very protection against blood loss. Let's try to figure out how the natural system of hemostasis works.

Blood is always in a liquid state. Moreover, this liquid has a certain composition and physical parameters. The systems of the body tirelessly maintain this state throughout life. However, various situations occur: for example, as a result of damage to the vessel wall, it opens. The first substance released into the blood is thromboplastin. It starts the work of the coagulation system: it activates proteins that are normally present in the blood. These proteins form a clot at the site of violation of the integrity of the vessel. A chain leading to thrombus formation is carried out: from prothrombin thrombin is synthesized, which activates fibrinogen, from which, in turn, is formed fibrin. It is in fibrin, like insects in a web, that platelets get stuck, forming a blood clot. The fibrin clot "patches" the wound in the vessel, the bleeding stops.

In a healthy body, both systems - coagulation and anticoagulation - are in balance. But there is also a third system - absorbable (). It is she who ensures the dissolution of the blood clot after the restoration of the integrity of the vessel. The indicators of the coagulogram make it possible to draw a conclusion about the state of all systems.

Basic parameters of the hemostasiogram

1. . The most important test of the state of the coagulation system.
2. , INR (international normalized ratio), PTT (prothrombin time). Usually one of these analyzes is performed, based on the equipment available in the laboratory. The most universal test is . All of these studies show an extrinsic clotting pathway.
3. . In the test, you can find an abbreviation - APTT.

Additional parameters of the hemostasiogram

• Protein C. An insufficient amount of this parameter leads to thrombosis.
• . Like protein C, it belongs to the factors of the anticoagulation system.
• . It is formed as a result of the destruction of a blood clot.
• Plasma tolerance to heparin.
• AVR (Activated Recalcification Time).
• (soluble fibrin-monomeric complexes).
• Plasma recalcification time.

Carrying out a coagulogram during pregnancy

Who, being perfectly healthy, gets the most research? Undoubtedly, these are pregnant women. Numerous ultrasounds, tests, analyzes, examinations - all these tests must be passed by the expectant mother for the birth of a healthy child. The list of necessary studies of pregnant women includes a coagulogram. The data of the analysis characterize hemostasis and allow early detection of disorders in this system. In the body of the expectant mother, many processes do not go the way they did before pregnancy. In particular, the activity of hemostasis increases, which is normal.

However, there are deviations from the norm. And this is already becoming dangerous for both the mother and the child. Violation of the blood systems can lead to irreparable consequences. In order to detect and neutralize all kinds of problems in time, a hemostasiogram is performed.

What is the activation of the hemostasis system during pregnancy?

1. First, the hormonal background of a woman changes.
2. Secondly, a new (uteroplacental) circle of blood circulation appears.
3. Thirdly, the body of a pregnant woman prepares for the inevitable blood loss during the birth of a child.

In case of violation of blood clotting during pregnancy, there is always a risk of developing the so-called (disseminated intravascular coagulation), which is characterized at the first stage and hypocoagulation - at the second, that is, leads to. DIC is considered one of the most serious complications in obstetrics, it is often uncontrollable and endangers not only the life of the fetus, but also the life of a woman.

The opposite situation is possible. Blood due to a violation in the anticoagulant system is greatly liquefied. As a result, the risk of bleeding increases, especially during childbirth. In order to restore hemostasis, an analysis and further interpretation of the coagulogram is carried out. Based on the results of the study, treatment is prescribed.

Normally, this analysis is carried out in each trimester of pregnancy. Unscheduled if:

• The woman had miscarriages.
• Symptoms are observed preeclampsia: , swelling of the extremities, protein in the urine.
• Uterine hypertonicity (threat of miscarriage) is diagnosed.

There are many reasons for impaired hemostasis, but special attention to their condition should be paid to women whose relatives had a heart attack, stroke, varicose veins, diseases of the blood system.

Important! Among pregnant women, there is a widespread opinion about the dangers of any medication for the unborn child. But you can’t joke with the hemostasis system. A timely study and taking the necessary drugs will help a woman bear and give birth to a healthy child.

Study of the hemostasiogram

After a blood test, the coagulogram is deciphered. What indicators can be seen in the laboratory report, and what do they mean?

1. Fibrinogen

This enzyme is synthesized in the liver. Normally, this indicator ranges from 2 g / l to 4 g / l. For pregnant women, its increase is considered normal, but the content of fibrinogen, even in the third trimester, should not exceed 6 g / l. This is a very sensitive factor. Its reaction to inflammation, tissue necrosis has been established. Also, an increase can indicate infections, acute inflammatory processes (pneumonia), the onset of a heart or brain infarction, hypothyroidism, burns, contraception. If the amount of fibrinogen decreases, one can suspect a lack of vitamins (C, B 12), hepatitis, toxicosis, taking certain medications, cirrhosis of the liver. And, of course, the infamous DIC.

2. APTT

The time taken for the formation of a blood clot is studied. This indicator reacts sharply to changes in other coagulation factors. The norm of APTT is from 30 to 40 seconds. An increase in the parameter may indicate a lack of vitamin K, liver disease.

3. Prothrombin

Thrombin is synthesized from this protein in the liver when exposed to vitamin K. By changing the value of this factor, the state of the gastrointestinal tract and liver is judged.

4. Lupus anticoagulant

This indicator is assessed mainly when conducting a hemostasiogram in case of suspected antiphospholipid syndrome, or another autoimmune disease. IgM and IgG antibodies to phospholipids are produced in the blood (they are normally absent), which contribute to an increase in the APTT. Their appearance indicates preeclampsia or autoimmune diseases. Usually this situation ends badly: a woman loses a child.

table: normal indicators of the basic coagulogram

5. Thrombin time

Shows the conversion time of fibrinogen protein to fibrin. The normal setting is 11 to 18 seconds. Since the amount of fibrinogen increases during pregnancy, it is logical to assume that the thrombin time also lengthens. However, the indicator does not go beyond the limits of the norm. If the data is deviated from the norm, then this may indicate a lack or excess of fibrinogen in the blood.

6. Prothrombin time

This indicator means the time of formation of thrombin from its inactive form (prothrombin protein). Thrombin is needed for the formation of a blood clot, which helps to stop bleeding. If this indicator is increased, hypovitaminosis K, lack of coagulation factors, liver disease can be diagnosed.

7. Prothrombin index

One of the most important indicators. The plasma clotting time is compared in the norm to the same time in the patient. The PTI is expressed as a percentage. The normal rate should be in the range of 93-107%. A change in PTI can signal liver disease, risk. An increase in the rate can be observed during pregnancy, taking contraceptives. If blood clotting deteriorates, the PTI will be lowered. Since the prothrombin index is directly related to vitamin K, a decrease indicates a lack of this vitamin or poor absorption in the intestine (for example, with intestinal ailments). Taking aspirin or also lowers PTI.

8. Platelets

Blood cells that are most directly involved in maintaining hemostasis. The norm in the blood of these cells is from 150,000 to 400,000 per μl. With a decrease in the indicator, they are diagnosed. This may indicate maternal malnutrition. Platelets are synthesized in the bone marrow.

9. Antithrombin-III

It has a protein nature and is an antagonist of the thrombin enzyme. Its role is to inhibit the action of the coagulation system. This parameter is expressed as a percentage. The norm is from 71 to 115 percent. If the parameter is halved, the risk of thrombosis increases. With increased blood clotting, anticoagulants are prescribed. In this case, it is also necessary to control the indicator.

10. DIC

Normally, the coagulation and anticoagulation systems are in balance. If any of the factors of these systems is disturbed, the entire hemostasis is unbalanced. This is especially dangerous in pregnant women. The most formidable complication is disseminated intravascular coagulation. Activation of the coagulation system and fibrinolysis stimulates the development of DIC. As a result of the development of pathology in a pregnant woman, placental abruption, endometritis, can occur.

11. D-dimer

As a result of the incomplete disintegration of the fibrin fiber, rather large “fragments” appear - D-dimers. This is one of the main indicators of the coagulogram for pregnant women. The general norm is less than 500 ng / ml. However, in pregnant women, other parameters are considered normal. Already at the beginning of pregnancy, the indicator begins to grow, and before childbirth it exceeds the norm several times. Also, an increase can be observed in patients with diabetes mellitus, with kidney disease, with complicated pregnancy (preeclampsia), in old age.

12. Antibodies to phospholipids (Antiphospholipid syndrome)

The disease is autoimmune. The body begins to increase the number of antibodies to phospholipids. This is a series of symptoms that characterize arterial and venous thrombosis. Pregnant women diagnosed with APS are at risk of losing a child due to fetaplacental insufficiency.

13. Plasma recalcification time

An indicator of the formation of a fibrin protein clot. This parameter reflects the folding process as a whole.

14. Plasma tolerance to heparin

This test is carried out simultaneously with the previous one. Heparin is added to the plasma and the time of plasma recalcification is noted. If this indicator is less than the norm, changes in other factors of the coagulation system are possible. Suspected cirrhosis of the liver, hepatitis. With an increase in the parameter, one can assume the presence in the body of such diseases as, the state of pre-thrombosis, malignant tumors. However, normally an increase in the rate can occur in the last stages of pregnancy.

Important! It should be noted that only a specialist can decipher the coagulogram during pregnancy (as, indeed, for all other patients). It is unacceptable for one or another data to make a diagnosis and prescribe treatment.

Where to get tested and how much does it cost?

Anyone can take a blood test such as a hemostasiogram at one of the nearest medical centers, if he has at his disposal the necessary equipment and reagents. The cost of a coagulogram depends on the range of services and equipment of the center. Basically, the price of the basic package varies from 700 to 1,300 rubles (in Moscow). An extended coagulorogram costs about 3,500 rubles.

However, for pregnant women, a coagulogram is included in a number of mandatory studies and is free of charge. According to the CHI system, you can also do an analysis completely free of charge, having previously received a referral from your doctor.

How to submit?

The question “how to pass” in the case of analysis for a coagulogram is not at all superfluous. The results of the study depend on the correct preparation of the patient. This analysis is carried out in vitro(in vitro - outside the body). Blood is taken from a vein.

Blood is donated on an empty stomach. The last meal should be no later than 8-12 hours before the analysis. You can not drink any drinks (coffee, tea, and especially alcohol). Only clean water is allowed. The medications you are taking - especially those that affect the blood clotting process - must be indicated at the time of the test. The emotional state of the patient is very important. You need to try not to be nervous, to be calm, balanced. Muscle strain also negatively affects the results of the study. It is useful to drink an additional glass of cold water right before the test. The interpretation of the results is carried out only (!) By a specialist.