Thick blood or the problem of its increased clotting during pregnancy. Blood tests during pregnancy: coagulogram

But it happens that the degree of blood clotting exceeds the maximum allowable values for pregnancy (hypercoagulation) and such "protection" begins to work in an "attack", disrupting microcirculation in the area of implantation - attachment gestational sac(if we are talking about early terms) or in the uteroplacental system (in terms of more than 14 weeks), causing malnutrition of the baby, which, when progressing, can lead to the most unfavorable pregnancy outcomes.

To the group increased risk hypercoagulability during pregnancy includes women who have cardiovascular diseases who have previously experienced a stop in the development of pregnancy at any time, such complications of past pregnancies as preeclampsia, feto-placental insufficiency, premature detachment of the placenta. During the examination at the stage of preparation for pregnancy in such women are very often found to be carriers of special gene variants, leading to a tendency to microcirculation disorders (,). When such mutations are detected, compulsory examination hemostasis systems outside of provoking factors (outside of pregnancy, taking hormonal drugs, etc.).

Based on the results, an appropriate scheme for taking "blood-thinning" drugs is selected at the stage of pregnancy planning and an action plan is developed for the onset of pregnancy.

During pregnancy, such patients are monitored for the state of the blood coagulation system once every 4 weeks, even if "everything is fine."

Very often, hypercoagulability is an accidental finding during pregnancy and is detected only during a routine examination. (It is worth knowing what should be checked at least 3 times during pregnancy - at registration, then at 22-24 weeks, then at 32-34 weeks).

And, sometimes, the timely appointment of treatment can prevent a lot of problems with the development of the baby.

Blood is the main living environment, which plays a very important role in human body involving transportation different kind nutrients, oxygen and other components. Its condition directly determines the activity of internal organs in general and of cardio-vascular system.

Description

The medical term "hypercoagulation" (what it is, we will consider in this article) is a condition in which the activity of the blood coagulation system is increased. Pathology of this type could be like independent disease, and the manifestation of ailments associated with it. Hypercoagulation syndrome is mainly accompanied by an increased predisposition to thrombosis. The blood clot formed at the same time is not elastic and has a loose structure.

Serious problem

Blood clotting is pretty serious problem and must be vigorously combated. If the blood begins to thicken, then its property such as viscosity increases, the processes of tissue regeneration and oxidation are violated.

Hypercoagulability may be primary. In this case, hereditary predisposition is its cause. The secondary type occurs against the background of pathologies that are present in the body.

What is chronometric hypercoagulation? More on that below.

The reasons

Pathology can occur for a variety of reasons. The disease never appears spontaneously. The pathological process may be caused by the following factors:

During pregnancy for female body there is an additional load, as a result of which there is a violation of the activity of the blood coagulation system.
Intoxication with signs characteristic of dyspepsia, that is, with diarrhea and vomiting, and polyuria, provoked by kidney disease, diabetes, pulmonary edema, burns and injuries, often provoke blood hypercoagulation (which is interesting to many). Due to the loss of fluid in a large volume, the blood becomes highly concentrated. Dehydration causes problems brain activity and states blood vessels. When the patient's body recovers, the viscosity and volume of blood normalize.
The use of various kinds of medicines also causes dehydration. With long-term treatment of women with contraceptives hormonal type blood flow deteriorates. After completion of treatment, its concentration becomes normal.
As a result of excessive consumption of fatty foods, hypercholesterolemia develops. The blood is highly viscous. To push it through the blood vessels, the heart has to work harder.

Bacterial either viral infection body, as well helminthic infestations are accompanied in parallel toxic damage certain organs, blood vessels and blood clotting.
Both congenital and acquired fermentopathies slow blood flow and cause hypercoagulability.
Liver diseases such as cirrhosis and hepatitis disrupt oxygen balance and microcirculation.
Oncological pathologies - fibroids, hemangioma, myeloma, lipoma, certain types of leukemia.
Vascular and blood diseases - thrombophilia, varicose veins, atherosclerosis, erythremia, DIC, venous congestion.
Specific features of lifestyle - physical inactivity, smoking, overweight.
Diseases connective tissue systemic nature - scleroderma, systemic lupus erythematosus, vasculitis.
Surgical interventions performed on the heart, as well as prosthetics of the valves of this organ.
Amyloidosis, adrenal dysfunction.

Hypercoagulation syndrome is a problem from which no one can be immune. When confronted with it, you do not need to panic and try to heal yourself. You need to calm down, pull yourself together and go to an appointment with a specialist. With the thoughtless intake of blood-thinning drugs, everything can end very sadly.

The mechanism of development of hypercoagulability

If we consider the occurrence of hypercoagulation (what it is, we explained) from the point of view of the mechanism, then it appears as a result of a number of reasons. It:

increased concentration of procoagulants in the blood and their excessive activation, which is typical for thrombocytosis, as well as severe hyperfibrinogenemia and hyperprothrombinemia;
inhibition of anticoagulant activity in conditions such as sepsis, shock, DIC, burns;
deficiency and suppression of fibrinolytic coagulation factors in the presence of severe thrombotic syndrome, damage to the vascular walls, atherosclerosis, vasculitis.

In advanced cases, structural hypercoagulability causes the formation a large number blood clots in the microvasculature and main vessels.

How to determine the presence of pathology?

The complexity of diagnosing pathology this kind lies in the fact that hypercoagulability does not have any clearly defined clinical picture. Some patients with this syndrome have complaints of general weakness, lethargy, pain in the head area. To identify this disease, a laboratory test is required, which consists in taking venous blood. In this case, the laboratory assistant will immediately see that the biological material taken from the patient has signs of hypercoagulability, since the blood in this case will almost immediately clot in the needle.

Hypercoagulation therapy

If a patient has been diagnosed with a disease such as hypercoagulability in inner path blood clotting, you can not self-medicate, since its consequences can be unpleasant. He needs to contact any medical institution where they can provide qualified assistance. Specialists of a narrow profile will select individual therapy for such patients, taking into account all characteristic features specific organism.

Preparations

Most often, specialists prescribe drugs in this case (for example, the Thrombo ACC remedy, which has aspirin as the main component), which dilutes platelets. Along with them, it is also possible to use traditional medicine methods. For example, the meadowsweet, from which not only tinctures are made, but also preparations of various kinds. Its components are unique and can replace aspirin. Meadowsweet is prescribed by many doctors for diseases of the blood system and blood vessels, including hypercoagulability along the internal pathway of blood coagulation. If the treatment is to be a pregnant patient, then the therapeutic course should be chosen especially carefully. This category of patients is prescribed low molecular weight heparins. When treating hypercoagulation, it is allowed to take drugs such as Aspirin, Curantil, Pentoxifylline, Clopidogrel. They are appointed after consultation with a specialist.

In the treatment of patients who have other diseases along with this syndrome, "Sinkumar" or "Warfarin" are often prescribed, which are among the anticoagulants. If significant bleeding occurs during hypercoagulability (what it is now known), then patients require a transfusion of donor blood. In addition, it is possible to use saline or colloidal solutions.

To achieve the desired results from the treatment, patients are required to follow the instructions of their doctor with accuracy and adhere to such recommendations as:

conducting healthy lifestyle life;
rejection of all kinds bad habits(for example, smoking can become one of the factors contributing to the development of hypercoagulability along the internal pathway);
exclusion of significant physical exertion;
proper nutrition.

It is important to spend as much time as possible outdoors, in the fresh air.

Is it necessary to follow a diet with hypercoagulability?

If hypercoagulation syndrome was detected in patients in laboratory conditions, then experts recommend not only drug treatment, but also a change in their diet. It is mandatory to exclude such products as:

smoked meats;
fried and fatty foods;
various canned food;
marinades;
flour;
buckwheat;
sweets;
potato;
bananas;
too salty and spicy food;
carbonated drinks;
alcohol, etc.

It will also be useful to introduce into your daily diet sour-milk products that contain fat in minimum quantities, as well as vegetables, fruits, dark chocolate, cocoa, ginger root, garlic, artichokes, lemons, etc.

If the patient's hypercoagulability was provoked by sedentary or in the wrong way life, you need to urgently focus on your own health. The fact is that this category of patients is especially at risk of getting a stroke.

The specifics of the course of hypercoagulability during pregnancy

Hypercoagulation of the chronic type is often found in women who are carrying a child. This condition is normal, since the body of the expectant mother forms protective properties before childbirth, which means that there is an increase in blood clotting. In a pregnant woman, the level of fibrinogen can increase one and a half to two times. However, there are cases of a multiple increase in the rate of coagulation. This phenomenon cannot be ignored, since the fetus may die at an early stage, or placental abruption will occur ahead of time in the last trimester. The so-called hypercoagulable syndrome is known in medicine.

Hemostasis must be carefully monitored during childbearing, and for this it is recommended to undergo a coagulogram. If a pathology is detected, it is necessary to be treated in accordance with the instructions of the doctor. If this disease is detected in a timely manner, possible complications can be avoided.

We examined what it is - hypercoagulability.

Nature has taken care to make the human body unique. The main vital medium of the human body is blood, which ensures the normal functioning of every cell of the body due to its ability to carry vital oxygen, nutrients, trace elements, and also to help remove decay products and carbon dioxide from cells. The normal functioning of other organs also depends on the blood parameters. However, it happens that blood viscosity begins to increase, blood hypercoagulability develops, which many experts distinguish as a separate type of pathology, separating it from thrombohemorrhagic syndrome.

What is it - blood hypercoagulation and why does modern science give it the status of a separate pathological condition?

Hypercoagulability is a disease in which the blood becomes more viscous but does not occur; if blood clots still appear, they differ in their characteristics from blood clots that form in thrombohemorrhagic syndrome - their structure is not elastic, but loose.

May have extremely negative consequences, because changes in blood parameters entail changes in the processes of intracellular oxidation, which, in turn, will lead to changes in tissue regeneration processes (that is, the brain, kidneys, liver, and other vital organs will suffer).

The reasons

The causes of blood hypercoagulability in men and women are numerous and varied, the most common among them are:

hypodynamia;
bad habits, especially smoking;
overweight, and the stage of obesity does not matter;
vascular damage, including and;
the presence in the anamnesis of surgical interventions on the heart to replace the valve;
autoimmune pathologies;
(thrombophilia, erythremia, hemangioma and others);
body changes associated with reproductive function(use of hormonal and chemical contraceptives, pregnancy).

Symptoms

Symptoms of blood hypercoagulability in the patient are practically absent, are of a general nature and are similar to the symptoms of a large number of other, less dangerous diseases. In particular, in the presence of this syndrome, lethargy and fatigue are noted. And only a laboratory examination, in particular, a coagulogram, can show the presence of this disease, and there are no difficulties.

Deciphering indicators

Deciphering the analysis for hypercoagulation:

(normally, the indicators fluctuate in the range of 2.00 - 4.00 g / l) - the level of content increases.
prothrombin (normal) percentage- 78% - 142%) - increases.
Plasma tolerance to heparin (normally 7-15 minutes) is reduced in less than 7 minutes.
RFMK - test (norm - 3.36 - 4.0 mg / 100 ml) - increases.
TV, thrombin time (normally 12 - 16 seconds) - reduced.
APTT, activated partial thromboplasty time (normal values - 25 - 35 seconds) - is reduced.

Treatment

In matters of treatment of blood hypercoagulability, self-medication is unacceptable. Blood hypercoagulation requires medical correction, which is selected by a specialist strictly individually based on laboratory diagnostics and the patient's history.

There is a certain list of drugs that affect blood clotting, but only a doctor can decide which of these drugs to give preference, only certified specialist can develop a regimen for their intake and calculate the dosage.

As a rule, for the treatment of this particular pathological condition, drugs are used, the active substance of which is acetylsalicylic acid (Acetylsalicylic acid). For a certain category of patients, treatment of hypercoagulability based on the use of low molecular weight heparins is acceptable. That is, general approach in the choice of treatment for hypercoagulable syndrome does not exist, a specialized approach is required in this matter.

The most common in application are such industrial medicines from thick blood like aspirin, thrombo ASS, pentoxifylline, chimes, clapidogrel, warfarin, sincumar. is still debated among physicians.

Along with drug treatment, doctors prescribe the use of homeopathic remedies, do not disregard and. So, we can note the meadowsweet plant, the components of which have the same effect on the human body as aspirin. Tinctures made from the meadowsweet are widely used in the treatment of cardiological diseases.

To combat this disease, medication alone is not enough.

The positive effect of the use of drugs enhances and consolidates patient compliance with the following recommendations:

organization of a healthy lifestyle, getting rid of bad habits;
refusal of excessive physical exertion;
increasing the duration of stay in the fresh air;
development of the correct menu, the strictest observance in the presence of a diagnosis of blood coagulation: smoked meats, canned foods, citrus fruits, potatoes, flour products, alcohol, carbonated drinks should be excluded from the diet, do not eat spicy and overly salty foods. On the contrary, emphasis should be placed on daily consumption with a minimum percentage of fat, fresh fruits, vegetables; tea and coffee is better to replace with cocoa; from sweets to stop at dark chocolate. From citrus fruits with hypercoagulable syndrome, you can use lemon; from seasonings - ginger root, garlic.

The category of patients in whom the development of hypercoagulation syndrome was provoked by physical inactivity should not neglect the above recommendations and should radically reconsider their lifestyle, paying attention, first of all, to the intensity of physical activity. This is due to the fact that in the future such patients face real threat stroke.

During pregnancy

When considering this pathological condition, the development of hypercoagulability during pregnancy deserves special attention. During this period, the female body undergoes huge changes that are aimed at preparing for the upcoming birth. Don't skip it and circulatory system. Pregnant women tend to hypercoagulate because the blood clotting system is in a state of increased activity. The body is thus protected from during childbirth.

In addition, the development of hypercoagulability in pregnant women can be affected by concomitant deviations in health:

kidney and liver diseases,
disorders in the functioning of the heart and vascular system,
nervous tension, stress, depression,
age factor (the tendency to increased blood clotting increases after 40 years).

For the early detection of this pathology in a woman, the doctor observing the pregnancy prescribes a study of the coagulogram of the blood of the pregnant woman once a month. When diagnosing the onset of the pathological process, a suitable safe drug treatment is selected for a woman, recommendations are developed that relate to her lifestyle, as well as the daily menu; in this case, blood coagulogram control is carried out every two weeks.

Subject to the strict implementation of all medical prescriptions, a woman is able to normally endure pregnancy and give birth to a healthy baby.

The work of the cardiovascular system and all internal organs directly depends on its condition.

What causes the blood to thicken?

Hypercoagulation of blood in most cases is not accompanied by the formation of blood clots in the vascular bed. Despite the fact that laboratory tests will show the patient's tendency to rapid clotting, he should not panic and thoughtlessly take blood thinning drugs. If a blood clot forms in him, then his structure will be loose, because of which he will be deprived of elasticity.

The causes of hypercoagulability can be varied. Some patients developed blood problems due to cancer. In other people, the hereditary factor has become the cause of hypercoagulability. It is also worth noting the following factors that can change the composition of the blood:

vascular injury, including atherosclerosis;
thrombophilia (hematogenous);
overweight (any stage of obesity);
sedentary lifestyle;
bad habits;
erythremia, hemangioma or antiphospholipid syndrome;
undergone heart surgery, during which an artificial valve was installed;
autoimmune diseases;
pregnancy or taking contraceptives, etc.

How to identify pathology?

The complexity of diagnosing this pathology lies in the fact that hypercoagulability does not have a pronounced clinical picture. Some patients who have this syndrome complain of lethargy, general weakness, pain in the head. To identify this disease, it is necessary to undergo a laboratory examination, which consists in taking venous blood. The laboratory assistant will immediately notice that the biological material taken from the patient has signs of hypercoagulability, since the blood will almost instantly clot in the needle.

The study of venous blood allows you to confidently determine blood hypercoagulability

A coagulogram easily allows you to identify hypercoagulable syndrome, since during laboratory tests a change in the following indicators will be detected:

What is a hemostasiogram?

ZAO Laboratories TsIR What is a hemostasiogram?

blood coagulation system. Laboratory diagnosis of hemostasis disorders. Interpretation of results. Features of hemostasis during pregnancy. Molecular genetic analyses. platelet function.

Blood clotting tests are important to detect possible disorders in the hemostasis system, as well as to evaluate the effectiveness of therapy, dose selection and control of therapy to prevent complications. Only with the help of laboratory diagnostics it is possible to make an accurate diagnosis and adequately assess the effect of drugs.

High-quality laboratory diagnostics is very important for making the right decision by the attending physician. We use high quality foreign-made reagents, carry out internal control quality assurance and participate in external quality control programs. Comprehensive tests are formed together with clinicians who are our strict experts. We issue not only results, but also a detailed conclusion of a laboratory assistant on a hemostasiogram, determination of lupus anticoagulant, platelet aggregation.

The need for hemostasis studies can occur in a person of any age and gender! Our laboratory conducts examinations of women preparing for pregnancy and pregnant women; women taking contraceptives; patients receiving therapy with aspirin and heparin. Therefore, we provide excellent quality of research, which is highly valued by clinicians.

Our laboratory offers various types of hemostasis studies. Both screening tests, such as a baseline coagulogram, and complex research such as induced platelet aggregation.

Analyzes are taken in all three CIR clinics, which is convenient for our patients. Analysis results can be obtained from e-mail or by courier.

The hemostasis system performs two main functions: maintaining the blood in a liquid form inside the vessels on the one hand, and on the other hand, a quick response to damage to the vessels (the formation of blood clots to stop bleeding). Blood coagulation involves: the vascular wall, blood cells, blood plasma proteins. The plasma hemostasis system consists of three interconnected systems - the coagulation (coagulation) system, the anticoagulant (anticoagulant) system and the fibrinolysis (thrombus dissolution) system.

Coagulation parameters characterize the cascade leading to the formation of fibrin, a protein that forms the basis of a thrombus. Triggering of clotting can occur as a result of activation of the intrinsic and extrinsic pathways.

Blood clotting disorders: hypocoagulation- decrease in blood coagulation, manifested by bleeding, hypercoagulation- increased blood clotting, manifested by thrombosis, thrombophilia- Tendency to form blood clots.

Assessment of blood coagulation: hemostasiogram (coagulogram). Content of cellular elements of blood. Cellular elements (platelets, erythrocytes, leukocytes) ensure the formation of a primary plug in the damaged area. Activation of cellular elements is an important factor in triggering the plasma link of hemostasis. The inclusion of individual indicators of the general blood test in the hemostasiogram helps to correctly interpret deviations in the analysis and the clinical picture.

Screening tests for the study of the plasma link of hemostasis - APTT, prothrombin time, prothrombin index, Quick prothrombin, INR, thrombin time, fibrinogen, soluble complexes of fibrin monomers (RKFM).

APTT or APTT (activated partial or partial thromboplastin time) - assessment of the internal pathway of blood coagulation, the activator is phospholipids. APTT is the time required for plasma to clot when intrinsic pathway factors (calcium, phospholipids, and kaolin) are added.

Prolongation of APTT is observed with a deficiency of coagulation factors XII, XI, IX, VIII, kininogen, prekallikrein, factors V, X, prothrombin and fibrinogen, antiphospholipid syndrome, DIC.

Shortening of APTT is observed during hypercoagulation, including during pregnancy. 1 phase of DIC.

The property of APTT to lengthen with an excess of heparin makes it possible to monitor therapy with heparin drugs. Adequate prolongation of APTT - up to 2.5 times. When the APTT changes, it is important to control the APTT when corrected with normal plasma. Thus, the correction of elevated APTT with normal plasma indicates that the concentration of blood clotting factors is reduced in plasma. Lack of correction may indicate the presence of blood clotting inhibitors (for example, lupus anticoagulant).

Prothrombin time - the time required for plasma to clot when calcium and tissue factor are added. The method reproduces the external pathway of blood coagulation with an assessment of the so-called prothrombin complex - factors VII, X, prothrombin. Vitamin K-dependent clotting factors are involved in the extrinsic pathway, so PT is used to evaluate therapy. indirect anticoagulants.

There are three standard ways to present the results of this test: prothrombin index - the ratio of the PT result to the PT of normal plasma. Prothrombin according to Quick reflects the content of coagulation factors as a percentage, serves to assess the external coagulation pathway. INR (INR) - international normalized ratio. The patient's blood coagulation is compared with a special plasma normalized according to the international standard, which makes it possible to assess the state of the patient's external pathway of plasma hemostasis with a greater degree of reliability. This is important for evaluating the effect of drugs and dose selection.

Prolongation of PT (PI decreases, PC and INR increase) may indicate congenital deficiency of factors II, V, VII, X, liver disease with impaired function, vitamin K deficiency (malabsorption, cholestasis, nutritional habits, intestinal dysbacteriosis), treatment with indirect anticoagulants , decrease or change in the structure of fibrinogen.

Shortening of PT (PI increases, PC and INR decrease) indicates hypercoagulability, including during pregnancy and after childbirth, as well as when taking certain contraceptives.

Ways of expressing prothrombin test:

MIC - International Sensitivity Index

fibrinogen is a blood protein that is synthesized in the liver. When blood clotting starts, fibrinogen polymerizes to form fibrin.

An increase in fibrinogen concentration indicates a state of thrombophilia, observed with burns, in the last months of pregnancy, after childbirth, with myocardial infarction, after surgical interventions. In addition, the level of fibrinogen is increased during inflammatory processes, stress. A decrease in the amount of fibrinogen can be hereditary and acquired (impaired liver function).

Thrombin time (TV) is the time it takes for fibrin to form from fibrinogen. This indicator is estimated by the rate of blood clotting when thrombin is added. The rate of fibrin formation depends on the quantity and quality of fibrinogen and the presence of anticoagulants in the blood.

TB increases with a decrease in the concentration of fibrinogen and changes in its molecule, the presence of inhibitors of fibrin formation, autoantibodies to thrombin, paraproteinemia, elevated content fibrinogen / fibrin degradation products, the presence of heparin and other conditions. A decrease in TB is observed in the first stage of DIC and a significant increase in fibrinogen in the blood.

Thus, competent comprehensive assessment APTT results, indicators of prothrombin time, thrombin time and fibrinogen allows you to identify the presence of certain disorders, evaluate the effectiveness of therapy, suspect the risk of thrombosis or bleeding, allows you to prescribe necessary drugs and avoid drug overdose.

Anticoagulant system< p>A special system that includes several important proteins: antithrombin III, protein C and protein S does not allow a random start of the coagulation mechanism. Adequate work of the anticoagulant system is important condition maintaining the liquid state of the blood inside the vessels. A decrease in the activity of factors of the anticoagulant system can be the cause of severe thrombotic complications. In our laboratory, antithrombin III and protein C are determined.

Even in normal condition fibrinogen polymerization can occur in the body. But as soon as this process begins, the fibrinolysis system is launched to prevent blockage of blood vessels. Then fibrin cleavage products are formed in the blood - RKMF and D-dimers. An increase in the level of these factors indicates that the content of fibrin is increased. During pregnancy, fibrin is deposited on the surface of the placenta. With its excessive deposition, the permeability of the placenta is disturbed, which can be the cause of intrauterine fetal hypoxia and other complications of pregnancy. Determining the performance of the fibrinolysis system is used to diagnose the risk of pregnancy complications, as well as to diagnose DIC. The assessment of changes in fibrinolysis parameters should be carried out only with the participation of other indicators of hemostasis, since it does not reflect the place where the molecular mechanism of fibrinolysis is triggered. So, an increase in fibrinolysis can be observed with bruises, nosebleeds.

RKMF (soluble complexes of fibrin monomers)- a test for diagnosing the activation of blood coagulation inside the vessels. basis blood clot makes fibrin, which is formed from fibrinogen. This process goes through the stage of formation of fibrin monomers. Therefore, the definition of RKMF is used to diagnose the activation of blood coagulation inside the vessels.

RKMF increases with hypercoagulability, increased fibrinolysis, and an increase in fibrinogen concentration. During pregnancy, there is a physiological increase in the level of fibrinogen, therefore, RKMF are also often elevated. For a more accurate and complete diagnosis of intravascular coagulation, the determination of the level of D-dimers is used.

Features of blood coagulation during pregnancy During pregnancy, the third circle of blood circulation appears - placental. The placenta is the organ that separates the mother and fetus. The peculiarity is that in the placenta there is no capillary link from the mother's side. Directly from the spiral arteries, the mother's blood enters the intervillous space and the chorionic villi are washed by the mother's blood. Through the veins of the decudial membrane, the blood returns back to the mother's circulation. That is, the placenta is the boundary of the interaction of two organisms, an aggressive phase that leads to the activation of thrombotic mechanisms. Hidden tendencies of hemostasis disorders are more likely to appear in the arteries of the placenta and lead to additional excessive blood clotting. Many pregnancy complications arise from thrombosis of the spiral arteries. During pregnancy, the activity of factors of the internal pathway of blood coagulation increases, which is manifested by a shortening of the APTT. During pregnancy, the amount of fibrinogen increases, the level of RKMF and D-dimers increases. Despite these changes, normal pregnancy pathological activation of hemostasis is not observed, these changes are adaptive. Blood coagulation should preferably be assessed on different terms pregnancy. It is very important that the first blood coagulation test is done early in pregnancy. Then the likelihood of risks with the timely prescription of drugs will be minimal.

Excessive blood clotting leads to increased deposition of fibrin in the placenta and premature aging of the placenta. The appointment of specific therapy allows you to slow down this process and prevent premature aging placenta.

The hemostasiogram is a screening analysis and reflects the state of blood coagulation at the time of blood donation. Therefore, a hemostasiogram may not show those risks whose mechanisms have not yet been activated. Other studies are required to assess the risks of thrombophilia, which is the cause of miscarriage, severe preeclampsia, myocardial infarction, stroke and other thromboses. Of particular danger in obstetric and gynecological practice are hidden hereditary risk factors for blood clotting disorders. At the time of conception, each of us receives genetic material from our parents. In this genetic material, genes can be transferred that are associated with an increased risk of a particular condition. If both parents pass on such a gene, this condition is called homozygosity, if only one - heterozygosity. For some genes, a heterozygous state is sufficient, for the influence of others, a homozygous state. In order to find out if there are pathological genes and in what state they are (hetero- or homozygous), molecular genetic studies are carried out.

To assess the risks of pathology development in the hemostasis system, CJSC Laboratories TsIR conducts the following molecular genetic studies:

Polymorphism of the genes of the hemostatic system - 11 factors, including the frequently occurring Leiden mutation (f.V), mutation of the prothrombin gene, MTHFR mutation.

You need to take these tests if you answer "yes" to at least one of these items:

If there are two or more fetal developmental arrests in the early stages of pregnancy in the past
with several failed IVF attempts
in the presence of severe complications of pregnancy in the past (severe forms of late toxicosis of intrauterine death of the fetus, fetal growth retardation)
when detecting an increase in the level of antiphospholipid antibodies and / or an increase in the level of homocystema
in the presence of blood clotting disorders (thrombosis) in the past, in the presence of relatives with thrombotic complications under the age of 50 years (deep vein thrombosis, pulmonary embolism, stroke, myocardial infarction, sudden death)

Hypercoagulation (hypercoagulation syndrome): causes, forms, symptoms, tests, treatment

Hypercoagulability is a medical term for a state of increased activity in the blood clotting system. This pathology may be an independent disease or a manifestation of concomitant ailments. Hypercoagulation syndrome in most cases is accompanied by an increased tendency to thrombosis. The resulting blood clot is loose in structure and lacks elasticity.

Blood is the living environment of the body, which performs a transport function and ensures the delivery of oxygen and nutrients to all internal organs. It consists of plasma - the liquid part in which the cellular elements are located. The number of blood cells and plasma is in the ratio of 4:6. When this balance is disturbed, and the number of cellular elements begins to predominate, the blood thickens.

Blood clotting is a serious problem that must be actively combated. When the blood begins to thicken, its viscosity increases, the processes of oxidation and tissue regeneration are disrupted.

Hypercoagulability is primary. Its cause is hereditary predisposition. Secondary hypercoagulability develops against the background of existing pathologies in the body.

The reasons

The causes of hypercoagulability are very diverse. Pathology never arises spontaneously. This pathological process is provoked by the following factors:

During pregnancy, there is an additional load on the fragile female body, as a result of which the work of the blood coagulation system is disrupted.
Intoxication with signs of dyspepsia - vomiting and diarrhea, as well as polyuria due to diabetes mellitus, kidney disease, pulmonary edema, burns and injuries, are common causes of hypercoagulability. Abundant fluid loss makes the blood highly concentrated. Dehydration disrupts the brain and blood vessels. After the restoration of the diseased organism, the volume and viscosity of the blood are normalized.
Taking many medications also leads to dehydration. Long term treatment for women hormonal contraceptives impairs blood flow. Its concentration becomes normal after the end of therapy.
Hypercholesterolemia develops as a result of overuse fatty foods. In this case, the blood becomes very viscous. To push it through the blood vessels, the heart begins to work hard.
Viral or bacterial infection of the body and helminthic invasions are accompanied by toxic damage to target organs, damage to blood vessels, and blood clots.
Acquired and congenital fermentopathies slow down blood flow and lead to hypercoagulability.
Liver diseases - hepatitis and cirrhosis disrupt microcirculation and oxygen imbalance.
Oncopathology - hemangioma, myoma, lipoma, some forms of leukemia, myeloma.
hereditary predisposition.
Diseases of the blood and blood vessels - atherosclerosis, thrombophilia, erythema, varicose veins and venous congestion, DIC.
Lifestyle features - smoking, physical inactivity and overweight.
Surgical interventions on the heart, prosthetics of its valves.
Systemic connective tissue diseases - vasculitis, systemic lupus erythematosus, scleroderma.
Adrenal dysfunction, amyloidosis.

Hypercoagulability is a problem from which no one is immune. Faced with it, do not panic and self-medicate. You need to pull yourself together and see a doctor. Thoughtless use of blood-thinning drugs can lead to sad consequences.

diagram - distribution of causes of congenital hypercoagulable states

From the point of view of the mechanism, hypercoagulability occurs as a result of:

An increased concentration of procoagulants in the blood and their excessive activation, which occurs with severe hyperprothrombinemia, hyperfibrinogenemia, or thrombocytosis;
Suppression of anticoagulant activity in shock, sepsis, burns, DIC;
Deficiency and inhibition of fibrinolytic coagulation factors in severe thrombotic syndrome, damage to the walls of blood vessels, vasculitis, atherosclerosis.

Hypercoagulation in advanced cases leads to the formation of multiple blood clots in the main vessels and microvasculature.

Hypercoagulation and pregnancy

Chronometric hypercoagulability is often diagnosed in women who are carrying a child. This is due to the increased activity of the blood coagulation system of the mother and fetus. In turn, the hypercoagulable syndrome protects the woman's body from large blood loss during childbirth. Hypercoagulability during pregnancy occurs in the second trimester and is a variant of the norm.

The pathological increase in coagulation in pregnant women is due to various factors:

Diseases of the internal organs,
gene mutations,
Stress, conflict, depression,
Mature age - over 40 years.

To control hemostasis, all pregnant women need to donate blood once a month for a coagulogram and coagulation. If signs of hypercoagulation are detected, they are given a safe therapy that does not harm the fetus. Otherwise, thrombosis of the spiral arteries occurs in a pregnant woman, which leads to serious complications: delayed fetal development, rapid wear of the placenta, antenatal death.

Clinical picture and diagnosis

Hypercoagulation most often acts as a symptom of various diseases, but it can also be an independent disease that does not have a pronounced clinic. Slowing of the blood flow, its thickening, the formation of microclots is clinically manifested by headache, paresthesia, and general asthenization of the body. Patients complain of a deterioration in general well-being, lethargy, lethargy, apathy, drowsiness, absent-mindedness, hypertension, dry mouth, Bad mood, cold extremities.

Clinical signs of the disease may be absent. In such cases, it is possible to determine increased blood clotting only according to the results of laboratory tests, without which specialists will not be able to give an objective assessment of the situation.

In the absence of timely and adequate therapy hypercoagulation leads to the development of thrombotic and hemorrhagic complications.

To detect hypercoagulable syndrome, it is necessary to undergo a complete laboratory examination. To do this, patients take blood from the cubital vein for analysis.

In the laboratory, coagulogram parameters are determined and blood is examined for clotting. CBC, hematocrit measurements, and acid-base measurements complement the findings.

The diagnosis is established by characteristic features and laboratory tests of the hemostasis system.

Treatment

To restore normal blood flow and get rid of hypercoagulation, you need to visit a specialist who will diagnostic examination and provide expert assistance. Doctors in individually will select a treatment regimen taking into account all the characteristics of the body.

Treatment of hypercoagulability is aimed at eliminating the causative factors, conducting anti-shock therapy, restoring the volume of circulating blood, improving microcirculation, maintaining hematocrit at an optimal level, correcting hemodynamics and coagulation disorders:

Blood thinning drugs: aspirin-based drugs that prevent thrombosis: antiplatelet agents - Thrombo ACC, Cardiomagnyl, Acetylsalicylic acid»; anticoagulants - "Warfarin", "Heparin", "Fragmin"; fibrinolytics - Thromboflux, Fortelizin, Streptaza.
Symptomatic therapy - antispasmodics "No-shpa", "Papaverine", "Spasmalgon"; anti-inflammatory drugs - "Ibuklin", "Indomethacin", vascular preparations- "Pentoxifylline", "Curantil".
If there is a bacterial infection in the body, antibiotic therapy with the addition of antiproteases, for example, "Cefazolin" and "Kontrykal", "Azithromycin" and "Gordox".
To mitigate the developing state of shock saline solutions, plasma with heparin, Reopoliglyukin, albumin solution are administered intravenously.
With the development of anemia and a decrease in hematocrit, transfusions of erythrocyte mass or suspension are performed.
In autoimmune diseases, plasmapheresis is performed, steroid hormones are prescribed - Prednisolone, Dexamethasone.

In severe cases, patients are injected intravenously with colloid and crystalloid solutions, donated blood is transfused. Donor blood transfusions save the lives of patients after injuries accompanied by blood loss.

Along with the traditional drug therapy use traditional medicine recipes. Labaznik tincture is considered by herbalists to be a substitute for aspirin. This plant is used to treat not only blood diseases, but also the cardiovascular system. A decoction prepared from the fruits of hawthorn, red clover, valerian root, lemon balm, yellow sweet clover improves the condition of blood vessels and has a beneficial effect on the blood circulation process.

Diet therapy requires eating natural foods prepared by boiling, stewing or steaming. Foods enriched with vitamin E restore blood fluidity. A day is good to eat a tablespoon of sprouted grains of wheat. In the diet of patients must be present fermented milk products, vegetables, fruits, meat and fish dishes, seafood. Of the berries and fruits, the most useful are: cranberries, currants, cherries, grapes, apples, citrus fruits, peaches. Be sure to exclude canned, smoked, fatty, fried and pickled foods, sweets, muffins, buckwheat, potatoes, alcohol, soda.

Patients suffering from hypercoagulability should follow the main recommendations of specialists:

Quit smoking
Eat properly,
Lots of outdoor walks
Do sport,
Optimize your daily routine
get enough sleep
Avoid stressful situations and conflicts
Lead a healthy lifestyle,
Get blood tests done periodically.

The prognosis of hypercoagulable syndrome is ambiguous and depends on the severity of the underlying disease, general condition organism, existing changes in hemostasis.

Prevention of hypercoagulability consists in identifying patients at risk - pregnant women, the elderly and people with oncopathology, as well as in treating the underlying disease.

Hypercoagulability: what is it, causes and treatment

Blood is the main living medium that plays a very significant role in the human body, which consists in transporting various kinds of nutrients, oxygen and other components. Its condition directly determines the activity of internal organs in general and the cardiovascular system.

Description

The medical term "hypercoagulation" (what it is, we will consider in this article) is a condition in which the activity of the blood coagulation system is increased. Pathology of this type can be both an independent disease and a manifestation of ailments accompanying it. Hypercoagulation syndrome is mainly accompanied by an increased predisposition to thrombosis. The blood clot formed at the same time is not elastic and has a loose structure.

Serious problem

Blood clotting is a rather serious problem, and it must be actively dealt with. If the blood begins to thicken, then its property such as viscosity increases, the processes of tissue regeneration and oxidation are violated.

Hypercoagulability may be primary. In this case, hereditary predisposition is its cause. The secondary type occurs against the background of pathologies that are present in the body.

What is chronometric hypercoagulation? More on that below.

The reasons

Pathology can occur for a variety of reasons. The disease never appears spontaneously. This pathological process can provoke the following factors:

During pregnancy, an additional load is placed on the female body, as a result of which there is a violation of the activity of the blood coagulation system.
Intoxication with signs characteristic of dyspepsia, that is, with diarrhea and vomiting, and polyuria, provoked by kidney disease, diabetes mellitus, pulmonary edema, burns and injuries, often provoke blood hypercoagulation (which is interesting to many). Due to the loss of fluid in a large volume, the blood becomes highly concentrated. Dehydration causes disturbances in brain activity and the condition of blood vessels. When the patient's body recovers, the viscosity and volume of blood normalize.
The use of various kinds of medicines also causes dehydration. With prolonged therapy of women with hormonal-type contraceptives, blood fluidity worsens. After completion of treatment, its concentration becomes normal.
As a result of excessive consumption of fatty foods, hypercholesterolemia develops. The blood is highly viscous. To push it through the blood vessels, the heart has to work harder.

Bacterial or viral infection of the body, as well as helminthic invasions, are simultaneously accompanied by toxic damage to certain organs, blood vessels and blood clotting.
Both congenital and acquired fermentopathies slow blood flow and cause hypercoagulability.
Liver diseases such as cirrhosis and hepatitis disrupt oxygen balance and microcirculation.
Oncological pathologies - fibroids, hemangioma, myeloma, lipoma, certain types of leukemia.
Vascular and blood diseases - thrombophilia, varicose veins, atherosclerosis, erythremia, DIC, venous congestion.
Specific features of the lifestyle - physical inactivity, smoking, overweight.
Connective tissue diseases of a systemic nature - scleroderma, systemic lupus erythematosus, vasculitis.
Surgical interventions performed on the heart, as well as prosthetics of the valves of this organ.
Amyloidosis, adrenal dysfunction.

The mechanism of development of hypercoagulability

If we consider the occurrence of hypercoagulation (what it is, we explained) from the point of view of the mechanism, then it appears as a result of a number of reasons. It:

increased concentration of procoagulants in the blood and their excessive activation, which is typical for thrombocytosis, as well as severe hyperfibrinogenemia and hyperprothrombinemia;
inhibition of anticoagulant activity in conditions such as sepsis, shock, DIC, burns;
deficiency and suppression of fibrinolytic coagulation factors in the presence of severe thrombotic syndrome, damage to the vascular walls, atherosclerosis, vasculitis.

In advanced cases, structural hypercoagulability causes the formation of a large number of blood clots in the microvasculature and the main vessels.

How to determine the presence of pathology?

The complexity of diagnosing a pathology of this kind lies in the fact that hypercoagulability does not have any clearly defined clinical picture. Some patients with this syndrome have complaints of general weakness, lethargy, pain in the head. To identify this disease, a laboratory test is required, which consists in taking venous blood. In this case, the laboratory assistant will immediately see that the biological material taken from the patient has signs of hypercoagulability, since the blood in this case will almost immediately clot in the needle.

Hypercoagulation therapy

If a patient has been diagnosed with a disease such as hypercoagulability along the internal pathway of blood coagulation, one should not self-medicate, since its consequences can be unpleasant. He needs to contact any medical institution where they can provide qualified assistance. Specialists of a narrow profile will select individual therapy for such patients, taking into account all the characteristic features of a particular organism.

Preparations

To achieve the desired results from the treatment, patients are required to follow the instructions of their doctor with accuracy and adhere to such recommendations as:

maintaining a healthy lifestyle;
giving up all sorts of bad habits (for example, smoking can become one of the factors contributing to the development of hypercoagulability along the internal path);
exclusion of significant physical exertion;
proper nutrition.

It is important to spend as much time as possible outdoors, in the fresh air.

Is it necessary to follow a diet with hypercoagulability?

smoked meats;
fried and fatty foods;
various canned food;
marinades;
flour;
buckwheat;
sweets;
potato;
bananas;
too salty and spicy food;
carbonated drinks;
alcohol, etc.

It will also be useful to introduce into your daily diet fermented milk products that contain minimal amounts of fat, as well as vegetables, fruits, dark chocolate, cocoa, ginger root, garlic, artichokes, lemons, etc.

If a patient's hypercoagulability was provoked by a sedentary or unhealthy lifestyle, it is urgent to focus on one's own health. The fact is that this category of patients is especially at risk of getting a stroke.

The specifics of the course of hypercoagulability during pregnancy

Hypercoagulation of the chronic type is often found in women who are carrying a child. At the same time, such a state is normal, since the body of the expectant mother forms protective properties before childbirth, which means that there is an increase in blood clotting. In a pregnant woman, the level of fibrinogen can increase one and a half to two times. However, there are cases of a multiple increase in the rate of coagulation. This phenomenon cannot be ignored, since the fetus may die at an early stage, or placental abruption will occur ahead of time in the last trimester. The so-called hypercoagulable syndrome is known in medicine.

We examined what it is - hypercoagulability.

Hypocoagulation. Hemorrhagic syndrome

The following mechanisms underlie the decrease in blood clotting: 1) a decrease in the concentration of procoagulants in the blood; 2) insufficient activation of procoagulants; 3) increased concentration or excessive activation of anticoagulants; 4) increased concentration or excessive increase in the activity of fibrinolytic factors.

Procoagulant deficiency (the first mechanism) is very common. It may be due to thrombocytopenia, thrombocytopathy, insufficient or impaired synthesis of various plasma factors coagulation, excessively increased consumption of these factors in the process of coagulation.

I. Thrombocytopenia. According to pathogenesis, they are divided into the following types:

1) associated with increased destruction of platelets as a result of: a) immune conflicts; b) mechanical destruction (splenomegaly);

2) associated with a lack of platelet formation due to: a) a decrease in the proliferation of unipotent bone marrow cells - platelet precursors (aplastic anemia); b) replacement of the bone marrow with tumor tissue; c) lack of vitamin B 12 and folic acid;

3) associated with their increased consumption (usually with multiple thrombosis). Most common cause thrombocytopenia is an increased destruction of cells. In this case, an inherited defect in the structure of platelet membranes or a decrease in the activity of glycolysis enzymes or the Krebs cycle are usually found. As a result, a significant shortening of the life span of platelets (several hours, instead of 7–10 days) and an increase in their destruction in the spleen. At the same time, there is an increase in the formation of platelets per unit of time. The reason is an increase in the level of thrombopoietins due to thrombocytopenia.

AT clinical practice most often found:

a) drug thrombocytopenia. It is diagnosed on the basis of the coincidence in the time of taking the drug and the development of thrombocytopenia (may be caused by taking estrogens, thiazide diuretics, anticancer drugs, ethanol, etc.);

b) autoimmune thrombocytopenia - the result of increased destruction of platelets under the action of antiplatelet antibodies (usually develops in previously healthy people);

c) thrombocytopenia in pregnancy. It occurs in 5-10% of pregnant women and usually does not cause serious complications in the woman and the fetus;

d) thrombocytopenia due to HIV infection. Thrombocytopenia is often found in HIV carriers and may be the first manifestation of infection;

e) thrombocytopenia due to transfusions. It can develop after massive blood transfusions or the use of cardiopulmonary bypass, which is due to the dilution of platelets in the blood or their mechanical removal. Such thrombocytopenia persists for 3-5 days and can be corrected by platelet transfusion. Signs of the disease usually appear about 7 days after the blood transfusion. Thrombocytopenia of this type is usually severe and may be accompanied by intracranial hemorrhage;

f) thrombotic thrombocytopenic purpura - a rarer syndrome characterized by thrombocytopenia, microangiopathic hemolytic anemia, transient neurological disorders, often associated with fever and kidney damage. The diagnosis is made on the basis of symptoms of microangiopathy - fragmentation of red blood cells in smears of peripheral blood, increased levels of reticulocytes and serum lactate dehydrogenase activity - in the absence of signs of DIC according to laboratory data.

However, it must be remembered that usually when the content of platelets in the blood is more than 1 μl, significant bleeding is not observed; if the number of platelets exceeds 1 μl and there are no disorders associated with blood clotting factors or platelet function, then severe spontaneous bleeding is rare.

II. Thrombocytopathies. Thrombocytopathies (TP), unlike thrombocytopenias, are characterized by stable, long-lasting functional, biochemical and morphological changes in platelets, which are observed even with their normal number and do not disappear when thrombocytopenia is eliminated, if it was combined with platelet dysfunction.

By origin, thrombocytopathy is divided into: 1) hereditary and congenital (primary); 2) acquired (secondary).

The reasons- physical, chemical and biological factors. Types of TP: 1) with a predominant violation of the "contact" activity: aggregation and / or adhesion of platelets (disaggregation TP); 2) with a predominant violation of the "clotting" (procoagulant) activity of platelets ("discoagulation" TP).

Pathogenesis: 1) violation of the synthesis and accumulation of biologically active substances in platelets and their granules: procoagulants, factors of the coagulation and fibrinolytic systems; 2) violation of the reactions of "degranulation" and "release" of platelet factors into the blood plasma; 3) violation of the physicochemical properties and structure of platelet membranes (change in surface charge, violation of the conformation of membrane glycoproteins, proteins, etc.).

An example of hereditary disaggregation thrombocytopathy is Glanzman's thrombasthenia. This pathology was first described in 1918 as a hereditary, recessive autosomal type of hemorrhagic diathesis, characterized by a lengthening of the time capillary bleeding(according to Duke) and the absence or sharp weakening of the retraction of the blood clot with a normal or almost normal content of platelets in the blood. Type of bleeding - microcirculatory: slight appearance of pitechiae and ecchymosis on the skin, a decrease in vascular resistance ( positive test pinch, jar), recurring nasal and gingival bleeding, menorrhagia, bleeding during tooth extraction, etc. are possible.

A fundamental role in the origin of Glanzman's thrombasthenia is played by the absence of a complex of glycoproteins (IIb and IIIa) in the membranes of platelets, which are necessary for the interaction of these cells with aggregation stimulators and fibrinogen. The prognosis for thrombosthenia is favorable in most cases, but worsens with hemorrhage in the brain and retina. The hemorrhagic syndrome in this pathology is noticeably more pronounced in childhood and adolescence and in females.

In the clinic, some patients show signs of a simultaneous violation of both "contact" and "procoagulant" platelet activity. So, with Wiskott-Aldrich syndrome (a hereditary disease occurring in boys, transmitted recessively, linked to the X chromosome), there is a violation of the synthesis and storage of granule components various types, as well as releasing their contents. This is accompanied by a disorder of the adhesive, aggregative and procoagulant activity of platelets.

Clinical manifestations of thrombocytopathies are devoid of pathognomonicity and usually consist in hemorrhagic syndrome.

Violation of the synthesis of plasma factors. A number of procoagulants are formed in the liver. Therefore, the pathology of this organ is accompanied by a decrease in the synthesis of factors I (fibrinogen), II (prothrombin), V (proaccelerin), VII (proconvertin), etc. It follows that with liver damage, hypofibrinogenemia, hypoprothrombinemia, etc. are observed. Sometimes there is a violation of the synthesis of these factors. In such cases, they speak of dysfibrinogenemia, dysprothrombinemia, etc.

Many of the coagulation factors are synthesized in the liver with the participation of vitamin K (factors II, VII, IX, etc.) - these are the so-called "vitamin-dependent procoagulants". Their synthesis becomes sharply reduced if the level of this vitamin in the body is insufficient, which happens: 1) with insufficient formation of vitamin K in the intestine; 2) with liver pathology (absence of bile, violation of its absorption in the intestine); 3) when long-term use or an overdose of vitamin K antagonists (anticoagulants of an indirect mechanism of action).

A decrease or anomaly in the synthesis of procoagulants can be genetically determined. Example: hemophilia A - hereditary disease, which is based on the deficiency of antihemophilic globulin (f.VIII). Other types of hemophilia are possible. Their description is given in detail in textbooks.

There is a known mechanism for reducing the concentration of procoagulants in the blood, due to their binding by autoantibodies (these are factors V, VIII, IX). In this case, severe diseases (tumors, sepsis, etc.) play a provoking role.

The second mechanism for the development of hypocoagulation - insufficient activation of procoagulants (at their normal concentration) is largely associated with a decrease in the activating role of platelets (deficiency of factor 3, ADP). As a rule, it is observed with severe thrombocytopenia or thrombocytopathy. Violation of the activation of procoagulants can also be caused by disorders in the functioning of the kallikrein-kinin system (with liver disease, sepsis, an extensive inflammatory process, or a hereditary deficiency of the components of this system).

The third mechanism of hypocoagulation is associated with disorders in the system of anticoagulant factors. For example, with anaphylactic shock, other allergic reactions, some leukemias, radiation sickness, hyperheparinemia may occur. In liver pathology, the activity of antithromboplastins may increase. Finally, in autoimmune diseases, the appearance in the blood of pathological proteins with anticoagulant activity has been described.

The fourth way of development of hypocoagulation is excessive activation of fibrinolytic mechanisms. Massive release of tissue plasminogen activators into the blood can occur with extensive trauma, burns, tissue necrosis, and various toxic conditions. Microbial kinases may play a similar role in severe infectious diseases. Hypocoagulation under conditions of excess plasmin is explained by the fact that it cleaves not only fibrin and fibrinogen, but also coagulation factors V, VIII, etc.

To the reasons for the development of hypocoagulation (we have already touched on this), we should add the action of a group of drugs used to prevent and treat conditions of hypercoagulation and thrombosis. These are anticoagulants (heparin, vitamin K antagonists, etc.) and fibrinolytic drugs (fibrinolysin, streptokinases, etc.). Their overdose or improper administration is dangerous for the development of hypocoagulation and hemorrhagic syndrome. In addition, cytostatics can cause thrombocytopenia and disruption of the synthesis of procoagulants in the liver, and antibiotics can lead to the development of intestinal dysbacteriosis and, as a result, disruption of the endogenous synthesis of vitamin K and the corresponding hypovitaminosis. Finally, many drugs can cause the formation of autoimmune platelet pathology.

Hemorrhagic syndrome is manifested by a tendency to repeated hemorrhages and bleeding that occurs after a minor injury or even "spontaneously", without a cause that is sufficiently noticeable to the patient himself. Under conditions of hypocoagulation, even minor surgical operations (tooth extraction, etc.) can become deadly if preventive correction of impaired blood clotting is not carried out and vigorous measures are not taken to stop the onset of blood loss.

If hemorrhagic manifestations in a patient exist constantly or recur quite often, they speak of hemorrhagic diathesis (Greek diathesis - predisposition, tendency). Hemorrhagic diathesis characteristic of hereditary forms hypocoagulation (hemophilia, etc.), hereditary thrombocytopathies, prolonged thrombocytopenic conditions, chronic liver diseases, etc. Spicy hemorrhagic syndrome occurs as a complication of many forms of pathology - post-traumatic states, radiation sickness, leukemia, infectious diseases, medicinal disease.

It is necessary to pay attention to the fact that the hemorrhagic syndrome accompanies not only the state of hypocoagulation, but also some forms of pathology. vascular wall(vasopathy), for example, hemorrhagic vasculitis. This disease is based inflammatory process that affects capillaries and other small vessels and elevating their permeability (for erythrocytes and platelets) and violation of elasticity (increased fragility). Causes of vasopathy: 1) infectious-toxic; 2) hypovitaminosis (C,PP); 3) drugs.

The study of coagulation hemostasis is carried out using tests that record the time of clot formation in citrated plasma after the addition of calcium, phospholipids and the appropriate activating agent. staging accurate diagnosis one form or another of coagulopathy, the control of ongoing therapy is helped by the study of the patient's coagulogram - a comprehensive laboratory analysis of the blood coagulation system, including up to 20 different tests. As an example, I will focus on just a few of them.

1) Duke capillary bleeding time. Shortening of time - increased platelet aggregation or an increase in their number. Elongation - a decrease in the ability of platelets to aggregate or a decrease in the number of platelets. Normally it is 2-5 minutes.

2) prothrombin time- this is the time of formation of a blood clot after the addition of tissue thromboplastin (tissue factor and phospholipids) to recalcified plasma. Normally, PT is approximately 10–18 seconds, but can fluctuate significantly. With the help of PV, the activity of the external and general mechanisms of blood coagulation is assessed; this is the most sensitive method for diagnosing deficiency of factors VII and X. An increase in PT is also observed with a deficiency of factor V, prothrombin, and fibrinogen.

3) Activated partial thromboplastin time(APTT) is normally 30–40 s. It is measured as the time of blood clot formation after the addition of phospholipid to recalcified plasma that has been preincubated with inert particles causing contact activation of the intrinsic clotting mechanism. An increase in APTT indicates a decrease in the concentration of factors VIII, IX, XI or XII by 30% or more compared to the norm.

4) thrombin time is the time of clot formation after the addition of thrombin to the plasma. Normally, it is 14–16 s and may increase with DIC, hypo- and dysfibrinogenemia. Heparin also causes its increase, but the effect of heparin can be neutralized by adding protamine sulfate to the plasma. Reflects the state of the final stage of hemocoagulation - the formation of fibrin. Shortening of time - hypercoagulation.

5) fibrin degradation products(PDF) in serum is determined by the method of agglutination of latex particles carrying antibodies to PDF or fibrinogen. Enhanced level PDP (>8 µg/ml) occurs in DIC, thromboembolic complications, and during fibrinolytic therapy. Severe liver disease may cause a moderate increase in PDP; false positive results may occur in the presence of rheumatoid factor.

6) Ethanol test. It consists in the formation of a clot after 10 minutes at a temperature not exceeding 26 ° C - a qualitative indicator of latent hypercoagulation, indicating the presence of activated thrombin in the plasma.

7) The determination of the deficiency of individual blood coagulation factors is based on the change in the time of clot formation in plasma with a known deficiency of the hemostasis factor after adding the patient's plasma to it. The results of the study are expressed as a percentage of the activity of the mixed plasma of healthy donors. In healthy individuals, the activity of blood coagulation factors ranges from 60-160%, however, these limits should be determined independently in each laboratory.

8) The content of the von Willebrand factor (VWF) is determined in cases where the bleeding time is increased, the number of platelets is within the normal range and there is no obvious reasons platelet dysfunction. VWF is synthesized by endothelial cells and megakaryocytes; it forms aggregates containing from 2 to 40 or more subunits. VWF is essential for normal platelet adhesion. Determination of the cofactor activity of ristocetin is based on the ability of this antibiotic to stimulate in vitro the interaction of VWF with platelet glycoprotein. In most cases of von Willebrand disease, this figure is reduced.

During pregnancy, a woman's body is in a state of constant smooth restructuring. As the fetus develops, there are such changes in all organs and systems of the mother that allow both to function. The hemostasis system also adapts to new living conditions. It must ensure the liquid state of the circulating blood on the one hand and prevent blood loss on the other.

After the birth of the fetus and the rejection of the placenta, the bleeding should be stopped, nature took care of the solution - during the gestation of the pregnancy, the woman's blood gradually acquires an increased viscosity.

A characteristic increase in blood clotting occurs during the second and third trimester. The hemostasis system is rebuilt in such a way that increased important factors coagulation (from VIII to X). By the end of pregnancy, fibrinogen increases by 50%. Pregnant women do not feel these physiological changes.

If the indicators of the blood coagulation system exceed the limits of the norm adopted during pregnancy, they speak of a pathological hypercoagulable syndrome. It can be congenital - occurs due to the breakdown of some genes or acquired during life (as a result of certain diseases).

Hypercoagulability can lead to venous thrombosis. This is facilitated by, characteristic of pregnancy, slow blood flow in the lower extremities and varicose veins.

Congenital bleeding disorders include:

Leiden mutation (the antithrombotic clot breaking factor is lost).
Mutation in the region of the prothrombin gene.
Violation of the production of homocysteine.
Deficiency of antithrombin III.
An increase in factors VIII, IX, XI, or fibrinogen.
fibrinolysis disorders.
sticky platelet syndrome.
Polymorphism of the PAI-1 gene (plasminogen activator inhibitor-1) is the most common cause.
Hereditary deficiency of C protein and S protein.

In women with increased congenital coagulation, complications such as impaired implantation of the fetal egg, miscarriage, placental insufficiency, fetal malnutrition, premature detachment of a normally located placenta, thromboembolism, HELLP syndrome, nephropathy of pregnant women, purulent-septic complications, bleeding during childbirth, DIC syndrome.

Causes of acquired secondary coagulation disorders:

Taking oral contraceptives.
Smoking.
Prolonged bed rest.
Oncological diseases.
Diabetes.
Heart surgery to install artificial valves.
Autoimmune diseases.
Heart failure, hypertension.
Obesity.
Injuries.
Myocardial infarction.
Liver diseases.
Vasculitis.
Vascular aneurysms, varicose veins.

A number of diseases have genetic predisposition. These include antiphospholipid syndrome (APS). The causes of this disease are not well understood. The predisposing factor is considered to be infectious diseases and hereditary predisposition.

With APS, the functioning of the anticoagulant system is disrupted: adhesion and aggregation of platelets (the ability to stick and swell) increases, which leads to the development of blood clots in the lumen of the vessels, disrupting the full blood supply to the organs.

This pathology prevents the normal implantation of the embryo, causes abortion, fetal death, chronic DIC, and a number of other complications.

Outside of pregnancy, blood clotting can lead to strokes, heart attacks, thromboembolism, and retinal detachment. These complications can be avoided by timely diagnosis and treatment of increased blood clotting.

Diagnostics

In this condition, there may be complaints of dizziness, headaches, heaviness in the head, lethargy, weakness. When taking blood, its increased coagulability is observed, and the veins quickly thrombose.

During pregnancy, a woman is recommended to undergo an examination of the blood coagulation system (coagulogram). For this, blood is taken from a vein on an empty stomach, 12 hours before the study, it is necessary to exclude food intake and physical activity. With hypercoagulation, there are changes in the generally accepted norms for pregnant women, the following occurs:

Increased fibrinogen levels.
Decrease in protein C and antithrombin.
Shortening of APTT.
Reducing the number of platelets.
Shortening of clotting time and prothrombin time.
Increase in prothrombin index, D-dimer, platelet aggregation.
In congenital disorders, gene mutations are determined.
With antiphospholipid syndrome - the presence of anticardiolipin antibodies and lupus anticoagulant.

The interpretation of the test results is carried out by an obstetrician-gynecologist, if necessary, he recommends an examination by a hematologist, dopplerography of blood vessels, ultrasound of the fetus, and electrocardiography.

To eliminate risk factors for thrombosis, prevent circulatory disorders, complications during pregnancy and childbirth, therapeutic measures are carried out.

Treatment

With hypercoagulable syndrome, it is recommended to exclude smoked meats, legumes, walnuts, bananas, canned food from the diet, White bread, fatty foods, cream. The diet should be dominated by fresh fruits, vegetables, vegetable oils (especially linseed), juices, dairy products, fish, cocoa.

To prevent stagnation of blood in the vessels lower extremities recommend wearing compression stockings, physical exercises for pregnant women, walks in the fresh air.

Drug treatment depends on the cause of hypercoagulability, it is strictly individual, requires constant medical supervision. Prescribe anticoagulants, vitamins for pregnant women, folic acid, antiplatelet agents, plasmapheresis, iron preparations, polyunsaturated fatty acids, dipyridamole, low molecular weight heparins.

In the presence of autoimmune diseases, glucocorticoid hormones are prescribed. Delivery is carried out as through natural birth canal as well as operationally. The choice of tactics depends on the obstetric situation and the condition of the woman. In the postpartum period, prevention of purulent-septic complications is mandatory.