Coagulogram interpretation of indicators. Coagulogram - what kind of analysis is it, the correct interpretation of the results

A blood coagulogram, or hemostasiogram, is the result of a combination of blood parameters that can be used to determine the degree of its coagulability. Blood coagulation performs a protective function, because if the integrity of the blood vessel is violated, it can stop bleeding and prevent large blood losses. The analysis also has a different name - blood for a hemostasiogram or coagulation hemostasis.

Hemostasis is a special system in the body, the main task of which is to keep blood in a liquid state in the vessels, stop bleeding with damaged vessel walls and prevent the formation of blood clots. Blood coagulation is not the only mechanism aimed at maintaining the body and reducing blood loss. The primary functions of hemostasis are provided by platelets and special properties of blood vessels. That is why it is important to understand what a coagulogram is and why it is prescribed.

Expanded blood coagulogram

The indicators that are included in the blood test for a coagulogram are relative. For the completeness of the study in the expanded coagulogram, it is important to evaluate each blood coagulation factor. There are 13 of them, and omission in the analysis of at least one of them can lead to serious consequences.

An extended coagulogram is a combination of many indicators; such a study is carried out mainly in the diagnosis of specific hereditary diseases. Not every laboratory can conduct such a study, because it requires special expensive equipment.

In this regard, in practice, a set of basic indicators is often examined, the level of which, in combination with other analyzes of primary hemostasis, will make it possible to judge the general coagulation properties. This also requires knowledge of the total platelet count, bleeding time, platelet aggregation, and clot retraction.

For a more accurate diagnosis of certain diseases and in the treatment of low or excessively high blood clotting, it is required to obtain the results of all indicators, to determine the components of the blood.

A detailed coagulogram includes obtaining data on:

Retraction of a blood clot;

Thrombotest;

Plasma tolerance to heparin;

fibrinolytic activity.

Abbreviated coagulogram - what is this analysis?

The reduced set of indicators includes:

Coagulogram indicators

It is calculated by adding an active solution of thrombin to the plasma. The indicator is measured in seconds and indicates the ability to coagulate in the presence of a solution. Normally, this indicator is 15-18 seconds. An increased indicator may be with hereditary pathologies, indicate an increased value of blood coagulation inside the vessels and significant liver damage. This method is often used in drug treatment with the use of fibrinolytics and heparin.

The method for determining the retraction of a blood clot is similar to the method for determining thrombin time, it allows you to determine both the coagulability of a blood clot and the degree of its compression, the rate of the indicator is expressed in qualitative and quantitative values. The qualitative indicator can be 0 or 1, indicating the absence or presence of clot clotting. The norm of quantitative value is 40-95%. A decreased rate may be caused by thrombocytopenia, an increased one may be evidence of anemia.

Thrombotest - assessment of the presence in the blood. Normal thrombotest - 4-5 degree. The fibrinogen level should be in the range of 2.7-4.013 grams. If the level of this protein increases, the blood becomes thicker, and this can lead to the onset of the process of thrombosis. In pregnant women, this rate may fluctuate slightly.

In the process of determining plasma tolerance to heparin, it turns out how quickly a fibrin clot can form when heparin is added to the blood. Ideally, this process should take 7-15 minutes. Reduced tolerance to heparin is an increased period of time for clot formation, which may indicate liver disease. If the coagulogram of this indicator is less than normal, then this may indicate hypercoagulation.

The indicator of fibrinolytic activity allows you to identify the ability of blood to independently dissolve the formed blood clots over a certain period of time. The value is significantly affected by the presence of fibrinolysin in plasma. The norm is 183-263 minutes. Indicators below the norm indicate an increased degree of bleeding.

In what cases is a coagulogram shown?

In life, there are many situations in which it is extremely important to know the clotting indicators, so such a study is of great importance and is indicated for:

The presence of signs of bleeding, the frequent occurrence of hematomas under the skin from minor bruises;

Preparation for various kinds of operations;

Various diseases of the blood vessels;

after heart attacks and strokes;

After implantation of artificial heart valves, to assess the risk of emboli;

Identification of the reasons for the decrease in the immune functions of the body's defense;

Monitoring the condition of women during pregnancy and before childbirth. During this period, the indicators may fluctuate slightly, but this can be explained by hormonal changes in the body. The analysis allows you to determine whether there is a possibility of complications during childbirth, because some deviations from the norm can cause a miscarriage, premature detachment of the placenta, or cause severe bleeding. To control the condition of a woman during pregnancy, an analysis must be taken every trimester, and when the results are obtained, an increase in coagulability is often noted - this is how the body reduces the risk of possible blood loss.

An analysis of blood clotting is also necessary for the correct prescription of drug treatment when using drugs that stabilize various indicators of the body. In case of cardiac arrhythmia, varicose veins, stroke and coronary heart disease, a hemostasiogram analysis is performed to monitor the effect of drugs and timely diagnosis of possible deviations.

How to take a blood coagulation test?

It is important to follow some recommendations when taking an analysis to obtain reliable data. So, how to take a coagulogram?

It is necessary to donate blood on an empty stomach, that is, you do not need to eat 8-12 hours before the test.

It is forbidden to drink alcohol, including low-alcohol drinks, beer.

Physical activity on the body should be excluded 2-3 days before the test.

When taking any medications (especially anticoagulants), it is worth notifying the attending physician about this, it may be necessary to wait 1-2 weeks for their effect to cease and be removed from the body.

You should not do an analysis during menstruation, since the blood during this period in women is liquefied, so it will be almost impossible to determine the exact time of its clotting. The best time to take this analysis is the middle of the cycle.

You should not take a coagulogram analysis against the background of strong feelings and general fatigue. In this case, it is better to wait a while, as this may affect the results of the coagulogram and its interpretation. It is necessary to donate blood for a coagulogram in the morning before breakfast, after sleep and good rest.

In case of severe dizziness at the sight of one's own blood or injections, it is imperative to warn the nurse about this.

Interpretation of the results of the coagulogram

Clotting time

To determine it, take 2 ml of blood from the cubital vein. After that, without adding any substances, the blood is divided equally into 2 test tubes, which are placed in water, the temperature of which corresponds to the temperature of the human body, and a stopwatch is turned on. The tubes should be tilted slightly and the moment of clot formation should be monitored. A reliable result is the average value obtained from 2 test tubes, while the rate is considered to be 5-10 minutes.

If the result obtained exceeds 10-15 minutes, this may indicate:

Insufficiency of prothrombinase;

fibrinogen deficiency;

Vitamin C deficiency.

An indicator above the norm of blood clotting indicates hypercoagulability and leads to more platelet formation, which, in the absence of bleeding, can lead to blockage of blood vessels - thrombosis or thromboembolism.

If the value of blood clotting is reduced in the expanded coagulogram, then this condition is called hypocoagulation. In this case, the blood does not clot well or does not clot at all, which can lead to large blood losses even with minor damage to the vessels. Hidden internal bleeding is of particular danger, since it is not always possible to recognize them in a timely manner.

To diagnose diseases that can affect any indicator of blood coagulation, sometimes a blood test is not enough, and even an extended hemostasiogram cannot fully clarify the situation. The interpretation of the blood coagulogram should be carried out exclusively by the attending physician, and when evaluating the indicators, it is necessary to compare other groups of tests, take into account the biochemical blood test and have knowledge of specific changes in drug treatment. Therefore, having received blood tests for coagulation, you should not independently evaluate the results, and even more so take some measures aimed at stabilizing them.

prothrombin time

Determination of prothrombin time is almost the same as clotting, with the exception of adding calcium chloride solution and thromboplastin solution to the blood. The rate of blood clotting is 12-20 seconds. An upward deviation of the indicator when using this technique may indicate problems in the synthesis of the prothrombinase enzyme. This can lead to chronic liver diseases, lack of vitamins in the body, to dysbacteriosis.

High coagulation parameters may indicate the use of indirect coagulants, such treatment needs constant monitoring. The dosage is selected in such a way that the indicator increases by no more than 2 times. Hormonal contraceptives are also able to increase the prothrombin index.

ATCV

ATPV is a plasma reaction to the addition of erythrophosphatide and cephalin, which helps to establish clotting failure, and is also considered the most sensitive indicator. The normal APTT is 38-55 seconds. If the value is less than the minimum threshold, the formation of blood clots is possible.

Plasma fibrinogen

The determination technique is based on the property of plasma to turn into fibrin after the addition of special substances to it. After transformation, the fibrin strands are weighed. This allows you to get a quantitative indicator. The norm is a value ranging from 5.9 to 11.7 µmol per 1 liter of blood.

A low rate may indicate congenital diseases - fibrinogenemia or significant liver damage. An indicator above the upper limit of the norm of the coagulogram can indicate:

The presence of an infectious disease;

The development of malignant tumors;

Development of acute or chronic inflammatory processes;

Thromboembolism, taking into account the totality of data obtained from other studies;

Disruption of the thyroid gland.

In newborns, this indicator is significantly lower than in adults, the coagulogram norm ranges from 1.25-3.0 g / l.

In today's report, a coagulogram is considered: what kind of analysis, norm, decoding. For convenience, we have placed the data in tables.

A coagulation blood test is a comprehensive laboratory assessment of the state of hemostasis. The main function of hemostasis is to participate in the process of stopping bleeding and disposing of blood clots. The analysis allows you to diagnose malfunctions in the mechanisms of blood clotting, and is also required before any surgical intervention and in determining the causes of miscarriage.

Violation of the integrity of tissues and blood vessels activates the launch of a sequence of biochemical reactions of protein factors that ensure clotting during bleeding. The end result is the formation of a thrombus from fibrin strands. There are 2 main ways leading to blood clotting:

• internal - for its implementation, direct contact of blood cells and the subendothelial membrane of blood vessels is required;
• external - activated by protein antithrombin III, secreted by damaged tissues and blood vessels.

Each of the mechanisms individually is ineffective, however, forming a close relationship, they ultimately help to stop bleeding. Violation of the compensatory mechanisms of the hemostasis system is one of the causes of thrombosis or bleeding, which poses a threat to human life and health. This emphasizes the importance of timely diagnosis of the state of the hemostasis system.

Coagulogram - what is this analysis?

Patients often ask themselves the question - what is a blood coagulogram, for example, before surgery or during pregnancy, and why is it so important to donate it?

A coagulogram is a medical analysis to assess the state of the system that starts and stops the mechanism for blood clotting.

The obligatory examination before the operation is due to the possible risk of bleeding during the operation. If failures in the hemostasis system are detected, the patient may be denied surgical intervention if the risk of bleeding is too great. In addition, the impossibility of implementing one of the coagulation mechanisms may be the cause of miscarriage.

The effectiveness of therapy for any pathology affecting the hemostasis system requires strict control and is realized by means of the survey in question. Positive dynamics indicates the correctness of the chosen tactics and a favorable outcome. Lack of improvement requires immediate correction of the treatment regimen by a specialist.

What is included in a blood coagulogram?

Coagulogram parameters: prothrombin index (PTI), international normalized ratio (INR), fibrinogen protein, antithrombin (AT III), activated partial thromboplastin time (APTT) and protein fragment (D-dimer).

PTI and INR

With the help of two parameters - PTI and INR, it is possible to assess the normal functioning of the external and common pathways for blood coagulation. In the case of a decrease in the concentration of protein factors in the serum, a deviation of the criteria under consideration is observed in a larger direction from the norm.

It has been established that prothrombin is produced by liver cells (hepatocytes) and vitamin K is required for its normal functioning. In case of its hypofunction (deficiency), a failure occurs in the formation of a thrombus clot. This fact underlies the therapy of people with a predisposition to thrombosis and CVS pathologies. The essence of the treatment is the appointment of drugs that interfere with the normal synthesis of the vitamin. Both considered criteria are used to determine the degree of effectiveness of this tactic.

The formula for calculating the prothrombin index:

PTI std. is the amount of time taken for plasma to clot in the control sample after the addition of clotting factor III.

The INR coagulogram is calculated using the following formula:

IHI (International Sensitivity Index) is a standard coefficient.

It is known that the values ​​under consideration are characterized by an inverse correlation, that is, the higher the prothrombin time index, the lower the INR. The statement is also true for the inverse relationship.

fibrinogen

Synthesis of fibrinogen protein is carried out in hepatotocytes. Under the influence of biochemical reactions and degrading enzymes, it takes an active form in the form of a fibrin monomer, which is part of a blood clot. The lack of protein can be due to two reasons: congenital genetic mutations and its excessive depletion for biochemical reactions. This condition is characterized by excessive bleeding and poor blood clotting.

In addition, when the integrity of tissues is violated as a result of mechanical damage or inflammatory processes, the production of fibrinogen is significantly increased. Measurement of protein concentration allows diagnosing pathologies of the cardiovascular system (CVS) and liver, as well as assessing the risk of possible complications.

AT III

AT III is one of the most important factors, the main producers of which are hepatocytes and endothelium, which lines the internal cavity of the vessels. The main function is to suppress clotting processes by inhibiting the functioning of thrombin. Due to the normal ratio of these two proteins, hemostasis stability is achieved. Insufficient synthesis of antithrombin leads to increased coagulation processes and a critical level of thrombosis.

APTT

APTT in a coagulogram is a criterion that allows you to evaluate the normal implementation of the internal pathway. Its duration is directly dependent on the concentration of kininogen (the precursor of polypeptides) and various protein clotting factors.

The APTT value is set by measuring the time it takes to form a full-fledged blood clot when reagents are added to the test sample. The deviation of the criterion to a greater side from the norm leads to an increase in the frequency of bleeding, and to a smaller one - to excessive formation of blood clots. In addition, the isolated use of APTT is acceptable in order to reliably monitor the effectiveness of the use of anticoagulant drugs.

D-dimer

Normally, a thrombus should undergo destruction (destruction) over time. By measuring the D-dimer value, it is possible to establish the efficiency and completeness of this process. In the case of incomplete dissolution of the thrombus, an increase in the criterion is noted. In addition, D-dimer can be used to monitor the effectiveness of anticoagulant treatment.

The norm and interpretation of the blood coagulogram in adults in the table

All indicators of the coagulogram (which means each criterion and interpretation) are presented in the table.

Important: when selecting reference (normal) values, the age of the subject should be taken into account.

Peculiarities

A referral for a blood test for a coagulogram can be issued by a therapist, surgeon, gynecologist or hepatologist. Moreover, in each case, a certain set of criteria is selected. The determined indicators of the coagulogram can vary from two to a complete complex, including all 6 criteria. Extended analysis indicators are significant for a comprehensive comprehensive assessment of the functioning of the mechanisms that ensure blood clotting.

It should be noted that the decoding of blood coagulograms in adults should be carried out strictly by a specialist. Self-interpretation for the purpose of selecting treatment is unacceptable; this can lead to a complication of the disease and death. In addition, the analysis under consideration is not enough to make a final diagnosis. It should be used in combination with additional laboratory and instrumental methods.

Deviation from the norm

It should be noted that a slight deviation from the norm by tenths or hundredths of units has no diagnostic significance. This is due to daily fluctuations in all human laboratory readings, as well as individual characteristics.

Diagnostic value is acquired by significant deviations from the reference values ​​- by several units or more. A tenfold increase in the criterion indicates a severe stage of the pathology and requires immediate treatment.

Coagulogram during pregnancy

During pregnancy, a detailed analysis of the coagulogram is mandatory for all women. This fact is explained by the fact that a violation of the mechanisms that ensure blood clotting can occur for a long time without clinical signs.

The standard frequency of examination is once a trimester, however, if a woman has varicose veins, kidney or liver failure, or chronic autoimmune pathologies, then the frequency increases at the discretion of the doctor.

Normal values ​​for pregnant women

When deciphering the results, the exact week of pregnancy should be taken into account, since the indicators are different for each of them.

Who needs a coagulogram?

The main indications for an extended examination for a person:

• suspected DIC;
• carrying out the operation;
• frequent nosebleeds or bleeding gums;
• hematomas of unknown etiology;
• chronic anemia;
• heavy and prolonged menstruation;
• a sharp unexplained decrease in visual acuity;
• thrombosis;
• the presence in the anamnesis of relatives of violations of hemostasis;
• detection of lupus antibodies;
• CCC diseases with concomitant pathologies;
• intrauterine growth retardation;
• habitual miscarriages (permanent miscarriage of a child).

Hemostasiogram and coagulogram - what's the difference?

Often people are concerned about the question - what kind of tests are the coagulogram and hemostasiogram, and are there any differences between them?

The coagulogram is a part of the hemostasiogram, it allows you to evaluate the correct implementation of the clotting mechanisms themselves. In turn, the hemostasiogram is an extended diagnostic that takes into account the entire cellular composition of the blood (erythrocytes, neutrophils) and indicators included in hemostasis (hematocrit, thrombocrit).

How to take an analysis for a coagulogram?

The most reliable results are achieved with the exact implementation of the analysis methodology. Proper preparation for a blood coagulogram is also important.

The most common question is whether it is necessary to take a test for a coagulogram on an empty stomach or not? Yes, biomaterial should be taken strictly on an empty stomach. The minimum interval after the last meal should be 12 hours. The process of digestion of food is a complex multi-stage process, which involves all human biological fluids. Failure to follow this rule may result in false results.

Preparation for the examination also implies the exclusion of physical and emotional stress for a person at least 1 hour before the material is taken. Severe stress changes the state of human tissues, as well as the biochemical composition of fluids. And before going to the treatment room, it is recommended to sit in the laboratory for at least 15 minutes in a free position and try to calm down as much as possible.

Taking anticoagulant drugs significantly distorts the results, up to complete unreliability. Therefore, they, like any other medications (including oral contraceptives), must be excluded for 3 days. If not possible, notify the laboratory staff of all medications taken.

For 30 minutes it is forbidden to smoke, and for a day - to drink alcohol. A minimum of 1 month should elapse from the moment of blood transfusion, as this can significantly distort the value of fibrinogen and APTT.

What influences the result?

In the event of even one of the following conditions of damage to the biomaterial, the analysis must be canceled, the result is considered invalid:

• violation of the temperature regime of storage or taking of biomaterial;
• hemolysis - destruction of red blood cells;
• the presence of fatty inclusions in the serum;
• the volume of red blood cells critically deviates from the norm;
• the presence of anticoagulant molecules in the biomaterial as a result of taking drugs.

It is necessary to re-sample the biomaterial in compliance with all the rules.

How many days is a coagulogram done?

In the state clinic, it is possible to take an analysis with a minimum set of indicators, as a rule, this is a coagulogram of PTI and INR. The term of execution does not exceed 1 day, not counting the day of taking the biomaterial.

Private clinics offer both a limited analysis option (the price starts from 200 rubles) and an extended full one (from 1500 rubles). The duration is similar to state laboratories.

Thus, summing up, it must be emphasized that:

• timely detection of hemostasis disorders can significantly reduce the risk of possible bleeding or excessive clotting, threatening the formation of a blood clot;
• before handing over the biomaterial, it is important to properly prepare;
• these laboratory parameters are not enough to make a definitive diagnosis, because a deviation from the norm can be caused by a number of pathological conditions. Determining the final diagnosis involves the use of additional laboratory and instrumental diagnostic methods.

One of the most important of these analyzes is the coagulogram. It is worth explaining in more detail what this study is.

What is a coagulogram

During the study, the functioning of hemostasis, the blood coagulation system, is checked. In our body, it is always liquid. When bleeding, the blood thickens, thereby preventing its abundant loss. This is how it should be normally. A blood coagulogram allows you to identify if there are any deviations and disorders during the operation of the coagulation system. There is an extensive list of situations in which the analysis of the hemostasiogram is mandatory:

1. Pregnancy. Blood clotting is certainly checked every trimester. If there are complications, the analysis is done more often.
2. Upcoming surgery.
3. Varicose veins, thrombosis.
4. Autoimmune diseases.
5. Problems with the heart, blood vessels.
6. Diseases of the liver.
7. The appointment of hormonal contraceptives, anticoagulants, aspirin.
8. Hirudotherapy (treatment with leeches).

Coagulogram indicators

In the laboratory, the collected blood is tested for certain biochemical characteristics. The study of hemostasis can be basic or detailed. What does a standard coagulogram show:

• fibrinogen;
• APTT (activated partial thromboplastin time);
• prothrombin;
• platelets;
• PTI (prothrombin index), PTT (prothrombin time), INR (international normalized ratio);
• thrombin time.

What is included in the extended type coagulogram in addition to the indicators listed above:

• antithrombin;
• protein C;
• D-dimer;
• the degree of plasma tolerance to heparin;
• plasma recalcification time;
• RFMK (soluble fibrin-monomer complexes);
• lupus anticoagulant;
• AVR (activated recalcification time).

Coagulogram, decoding

Probably, listing all the indicators will tell little about anything to an ordinary person without a medical education. To understand a coagulogram - what kind of analysis it is, you need to explain what each of them means for the body. Without this, the picture will not be complete. Basic blood coagulogram, decoding:

1. fibrinogen. An enzyme produced by the liver. In the presence of inflammatory processes in the body, its level greatly increases.
2. APTT. Indicates how quickly a blood clot appears.
3. Prothrombin. A protein that interacts with vitamin K. When they are combined, thrombin is obtained.
4. platelets. Cells, the number of which indicates the state of the body as a whole.
5. PTI. The rate of plasma coagulation is compared with that of the patient.
6. PTV. Indicates how much it takes for thrombin (a substance that makes liquid blood clot) to be converted from prothrombin (an inactive form of a protein).
7. INR. External coagulation index is a combination of PTI and PTV.
8. thrombin time. Shows how quickly fibrin is formed from fibrinogen.

Extended coagulogram

Such an analysis for blood clotting is prescribed if it is necessary to clarify the results of the baseline. In addition, an expanded coagulogram can be prescribed if one or another pathology is detected. Deciphering indicators:

1. Antithrombin. A substance that prevents blood clotting.
2. D-dimer. An important indicator for women during pregnancy.
3. Plasma recalcification time. The overall process of coagulation is characterized by this indicator.
4. Plasma tolerance to heparin. According to the result, the presence of diseases of the heart, blood vessels, and oncology is determined.
5. Protein C. With its deficiency, thrombosis may occur.
6. RFMK. An indicator characterizing the process of intravascular blood coagulation.
7. Lupus anticoagulant. The presence of antibodies during pregnancy indicates preeclampsia or autoimmune diseases of the child.
8. AVR. Determination of plasma recalcification time by an alternative method.

Learn more about D-dimer - what it is, indicators of the norm during pregnancy and its planning.

Preparation for coagulogram analysis

The patient must follow certain rules before screening. Preparation for a coagulogram involves:

1. Refusal to eat 8-12 hours before the procedure. If you are going to have dinner the day before, choose a light meal, but it is better to come for an analysis on an empty stomach.
2. Cancellation of all medications that are allowed to take a break.
3. Refusal of any drinks other than water, especially alcohol.
4. Decreased physical activity. Try not to overload your body before analysis.
5. Avoidance of stressful situations, nervousness.
6. Refrain from smoking at least one hour before you need to take the test.

The doctor must take blood from a vein without using a tourniquet so that the body does not start the process of hemostasis, which may distort the results. It is important that the patient is not injured during the puncture, otherwise additional substances will enter the material for analysis that can change its quality. Blood is collected in two test tubes. The first indicators can be determined instantly.

How much is a coagulogram done

The time frame depends on many factors. How much a coagulogram is done is affected by the workload of the laboratory and a particular specialist, the availability and serviceability of all the necessary equipment. As a rule, the results are known in a day or two after blood sampling. In rare cases, this period increases to 5-10 days. in most laboratories, by paying extra for urgency, you can find out the results of the hemostasiogram right on the day of delivery.

Coagulogram analysis norms

In the table below you will see what indicators should be obtained in a healthy adult. Coagulogram analysis norms:

thousand cells per µl.

Less than 500 ng/ml

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The analysis is done in each trimester and unscheduled if pathologies and abnormalities are detected. Blood for a coagulogram during pregnancy is given so often because any changes in the analysis may indicate the appearance of serious problems in the body of both the woman and the baby. Some indicators differ significantly from the norm for an ordinary person, which is caused by hormonal changes. Changes in the coagulogram in pregnant women:

1. The level of fibrinogen in the last trimester can reach 6 g/l.
2. PTI increased.
3. Lupus anticoagulant is not necessarily present.
4. APTT decreases dosec.
5. D-dimer is significantly greater than 500 ng/ml.
6. Plasma tolerance to heparin is increasing.

Video: coagulation studies

The information presented in the article is for informational purposes only. The materials of the article do not call for self-treatment. Only a qualified doctor can make a diagnosis and give recommendations for treatment based on the individual characteristics of a particular patient.

A coagulogram is a blood clotting test that warns of hidden and overt pathologies

A coagulogram is a complex detailed study aimed at determining the main blood factors that characterize its ability to coagulate. Blood clotting is one of the basic functions that ensure the normal functioning of the body, and a deviation from the normal indicators of several parameters threatens either increased bleeding or rapid blood clotting into dense clots. Comprehensively evaluating the data of the coagulogram, a competent doctor will diagnose and prescribe treatment in time, preventing the development of stroke, heart attack, renal and hepatic pathologies and dangerous complications during pregnancy.

Coagulogram - what is this blood test

A coagulogram is a special laboratory blood test that monitors the functioning of hemostasis - a complex biosystem aimed at maintaining blood fluidity, maintaining the processes of stopping bleeding, and timely dissolution of dense clots (thrombi).

In another way, an analysis that examines the work of hemostasis is called a hemostasiogram.

To maintain basic functions, the blood must be:

• liquid enough to carry oxygen and nutrients through the vessels to tissues and organs, remove decay products and toxins, support the immune system and thermoregulation;
• have a certain degree of viscosity in order to close gaps in large and small vessels in case of injury.

If blood clotting is reduced to critical values, in case of bleeding, this leads to massive blood loss and death of the body.

Excessive density and increased clotting (hypercoagulation), on the contrary, leads to the formation of blood clots that can block the most important vessels (pulmonary, coronary, cerebral) and lead to thromboembolism, heart attack and stroke.

An analysis of the hemostasiogram is of high importance, since a properly functioning hemostasis system prevents both life-threatening blood loss and spontaneous thrombosis and blockage of the vascular bed with blood clots.

The study is considered complex, since in order to understand the work of the blood coagulation system, the doctor must be able to evaluate each parameter individually and analyze all indicators in the aggregate.

The coagulogram contains a large number of parameters, each of which reflects a specific function of hemostasis.

There are two types of hemostasiogram:

• simple (basic, indicative, screening, standard);
• expanded (expanded).

The basic study reveals or excludes the fact of a violation in the functioning of the blood coagulation system. The analysis helps to find out in which link the deviation from the norm is determined, and then - if there is a suspicion of the development of the disease, an extended analysis is prescribed.

The standard coagulogram includes: prothrombin in% according to Quick or PTI, INR, fibrinogen, APTT, TV.

A detailed analysis provides for an extended study, during which not only the very fact of qualitative changes is determined, but also quantitative indicators.

A complete analysis of the coagulogram is carried out taking into account many clotting factors, the deviation of each of which from normal values ​​leads to serious problems. Without this, the study is considered indicative.

The expanded hemostasiogram, in addition to the indicators of the basic coagulogram, includes TV - Thrombin time, Antithrombin III, D-dimer.

In addition to them, several types of standard coalgulograms are carried out, including some indicators necessary to assess hemostasis in known conditions (before surgery, during pregnancy, anticoagulant therapy).

To whom and under what circumstances it can be assigned

A hemostasiogram is prescribed to a patient for the following diagnostic studies, diseases, conditions:

• a general idea of ​​the functioning of the hemostasis system;
• deviations from normal blood coagulation;
• planned and emergency operations (to avoid the risk of massive blood loss or, conversely, active thrombosis);
• vascular disorders in the lower extremities (deep vein thrombosis, varicose veins), pelvic organs, intestines, pulmonary embolism;
• hemorrhagic pathologies (hemophilia, hemorrhagic fever, thrombocytopathy, thrombocytopenia, von Willebrand disease, frequent nosebleeds, subcutaneous hemorrhages);
• stroke, atrial fibrillation, heart attack, coronary heart disease;
• pregnancy, childbirth, caesarean section;
• severe toxicosis;
• suspicion of DIC (intravascular disseminated coagulation);
• diagnosis of the causes of miscarriage;
• control of treatment with anticoagulants that thin the blood (Warfarin, Dabigatran, Trental, Heparin, Clexane, Fraxiparine, aspirin-based drugs);
• taking any contraceptive pills (analysis once every 3 months), since the substances that make up oral contraceptives can cause acute thrombosis in young women, often leading to serious conditions;
• chronic liver disease, including cirrhosis; assessment of the function of the synthesis of protein complexes - blood coagulation factors;
• autoimmune systemic pathologies (lupus erythematosus, rheumatoid arthritis, scleroderma);
• taking hormonal drugs, anabolics;
• hirudotherapy (treatment with leeches) to prevent hemorrhages (bleeding, subcutaneous hemorrhages).

How to properly prepare for an analysis

The price of an incorrect coagulation analysis is life-threatening bleeding or blockage of blood vessels with blood clots with a violation of the blood supply to important organs.

For the study to be reliable, elementary measures are necessary, which include the following preparation rules:

• infants up to 12 months of age do not feed in the interval of 30-40 minutes before blood sampling;
• children 1 - 5 years old do not feed in the interval of 2 - 3 hours before the study;
• for adults and young patients older than 5 years, stop eating 12 hours before the analysis;
• exclude physical activity and psychological stress 30 minutes before blood donation;
• stop smoking tobacco 30 minutes before the study;
• tell your doctor if you are taking any anticoagulants.

Where can I donate blood for clotting. Average price range

A hemostasiogram is carried out by qualified laboratory assistants in a polyclinic, a medical center, a laboratory that has the necessary equipment and reagents.

The cost of the examination is determined by the type of coagulogram (basic or expanded), the number of parameters to be determined and ranges from 350 to 3000 rubles. Patients who are expecting the birth of a child undergo a free examination if they have a compulsory medical insurance policy, since the examination belongs to the category of mandatory during pregnancy.

How is the analysis carried out

Blood is taken from a vein for a hemostasiogram. The blood sampling site is disinfected with an antiseptic and the skin is pierced using a syringe or a vacuum system. Injury to the vein and surrounding tissues is not allowed in order to prevent unreliable results due to the possible ingress of thromboplastin fragments from damaged tissues into the biomaterial for research.

For the same purpose, 2 test tubes are filled with blood, the last of which is sent for analysis.

How long it takes: how long to wait for results

The results of the coagulogram, as a rule, are obtained after 1 to 2 days. The turnaround time for the analysis is related to the volume of determined factors, the workload of the laboratory, and the specifics of the courier service.

Indicators and norms of analysis in adults and children

Considering that the process of hemostasis is evaluated in several systems of units and by several methods, the coagulogram parameters in different laboratories may differ.

It is impractical and even dangerous to independently analyze the coagulogram, since the specialist, when deciphering the indicators, takes into account many factors unknown to the patient, and their totality. Sometimes small deviations in certain indicators are dangerous, while deviations in others may not indicate serious diseases.

Deciphering indicators - what it is responsible for and what it means

By evaluating the parameters obtained in the hemostasiogram, the doctor is able to establish the cause of deviations from the norm and understand whether they occurred due to pathology in the coagulation system or due to other diseases that show similar indicators in the coagulogram, that is, to conduct a differentiated diagnosis.

Activated partial (partial) thromboplastin time is one of the most important parameters of hemostasis (other abbreviations APTT, ARTT). Denotes the time required for the formation of a blood clot after the introduction of certain reagents into the blood plasma. The values ​​of this indicator are directly related to changes in other hemostasiogram parameters.

Possible pathologies with APTT deviation

• low content of vitamin K, clotting factors, fibrinogen;
• taking anticoagulants, streptokinase;
• liver disease, glomerulonephritis;
• volumetric hemotransfusion (blood transfusion);
• presence of lupus anticoagulant;
• hemophilia, antiphospholipid syndrome, systemic lupus erythematosus;
• von Willebrand's disease;

• active malignant process;
• acute blood loss.

Fibrinogen level (Fib)

Fibrinogen (factor I) is a special protein produced by liver cells. At the site of vascular rupture, it turns into insoluble fibrin strands, which stabilize the mass of the thrombus that clogs the vessel and remains fixed until the injury heals.

Probable conditions and diseases with a change in the level of fibrinogen

• postoperative stage;
• pregnancy;
• Taking birth control pills;
• long-term inflammatory processes;
• atherosclerosis, smoking;
• heart attack;
• injuries with vascular damage, burns;
• rheumatism, nephrosis;
• malignant processes;

• children under 6 months;
• the use of thrombolytics (means for the destruction of blood clots), anticoagulants and antiplatelet agents;
• heart, liver failure;
• poisoning, including poisons;
• preeclampsia in pregnant women, DIC;
• complications after childbirth;
• mononucleosis;
• aggressive development of tumors, acute leukemia;
• fibrinogen deficiency.

Prothrombin (factor F II)

It belongs to the basic coagulation factors and is an inactive protein fraction, which, under the action of vitamin K, is transformed into active thrombin, which also takes part in the formation of a clot that stops bleeding.

If there is a deviation of factors I - II from the norm, this threatens to develop both bleeding and spontaneous thrombosis without damage and with the formation of pathological blood clots that can break away from the wall of a vein or artery and block the blood flow.

To understand the changes in the processes of hemostasis, determined by the concentration of prothrombin, coagulation tests are used:

• PTI (prothrombin index). This is the ratio, expressed as a percentage, between the individual time needed for blood clotting in a patient to the clotting time of the control plasma. The normal value is 97 - 107%. A low indicator indicates excessive blood fluidity, liver disease, vitamin K deficiency, diuretics, anticoagulants. An upward pathological shift (often when using birth control pills) indicates a dangerous thickening of the blood and the threat of thrombosis.
• PO (prothrombin ratio) - an indicator inverse of the PTI parameter;
• INR (international normalized ratio). Shows the rate of thrombus formation in percent. A typical case requiring an assessment of the INR is the patient receiving Warfarin, Warfarex, Finilin, Sincumar.
• PTT or Prothrombin Time (PT, PT, RECOMBIPL-PT). Specifies the interval (in seconds) required for prothrombin to transform into active thrombin.

Possible pathologies in case of PTV deviation

• lack of vitamin K, fibrinogen, clotting factors;
• taking anticoagulants;
• hemorrhagic diathesis (in infants and young children);
• spasm of the bile ducts;
• intestinal lipid absorption disorder;
• Zollinger-Ellison syndrome$

• pregnancy;

deviations in hematocrit (the volume of red blood cells);

Prothrombin in% according to Quick

Clotting time according to Lee-White

The parameter reflects the rate of platelet aggregation into a clot, indicating an increased activity of hemostasis and the risk of thrombosis (with a reduced rate), or an increase in the likelihood of bleeding if the time is increased.

Thrombin time (TT, TV)

The indicator expresses the rate of conversion of fibrinogen into fibrin fibers that fix the platelet clot at the site of injury.

Possible anomalous conditions in case of TV deviations from the norm

• low fibrinogen content;
• multiple myeloma;
• hepatic pathologies;
• high levels of urea in the blood (uremia);
• presence of D-dimers in plasma

• Stage 1 DIC in pregnant women;
• administration of heparin.

Coagulation enzymes

It reflects the level of activity of enzymes II, V, VII, VIII, IX, X, XI, XII, the values ​​of which are not associated with physiological causes, and a deviation from the norm always indicates the development of pathologies.

Plasma recalcification time and activated time (VRP and AVR, respectively)

Both studies measure the overall activity of hemostasis and the rate of fibrin clot formation, and differ only in the way the analysis is performed.

With reduced AVR, VRP, there is a risk of thrombosis. Elevated levels signal the threat of bleeding even with minor injuries from burns, shock, thrombocytopenia (low platelet count), and therapy with blood thinners.

Lupus anticoagulant

A protein complex, the level of which is determined in autoimmune pathologies, since normally there is no lupus enzyme in the blood. Its detection in the blood indicates a high risk of antiphospholipid syndrome (APS), which can cause placental insufficiency in preterm pregnancy.

D-dimers

Protein elements of fibrin remaining after the destruction of blood clots. Their increased number indicates too intensive formation of blood clots and the possibility of such conditions as: infections and inflammations, renal and hepatic failure, heart attack, thrombosis, sepsis, large hematomas, malignant tumors.

Sometimes an increase in dimers is observed after operations, in old age, against the background of the use of plasminogen.

Soluble fibrin-monomeric complexes (SFMK)

An increased concentration of these molecular-protein compounds (transitional products between fibrinogen and fibrin) warns of possible thrombosis.

platelets

Basic cells that support the processes of hemostasis, normally making up µl. With a decrease in the number, thrombocytopenia is diagnosed.

Protein C

A protein that can reduce the activity of coagulation processes, preventing the formation of large clots.

Antithrombin-III

A protein that is a physiological anticoagulant that is constantly present in plasma and most actively (by 75–80%) inhibits thrombin activity, preventing excessive blood clotting and thrombosis.

Probable pathologies in case of deviations of antithrombin 3 from the norm

• avitaminosis of vitamin K;
• menstruation;
• taking anabolics, means for thinning and enhancing blood clotting;
• cholestasis, pancreatitis or hepatitis in an acute form;
• kidney transplant;
• high levels of bilirubin;

• antithrombin deficiency 3 congenital;
• 26 - 40 weeks of pregnancy;
• the use of contraceptive medications;
• hepatic pathologies (insufficiency, cirrhosis);
• liver transplant;
• thrombosis, heart attack, pulmonary embolism;
• uncontrolled high-dose use of heparin;
• taking L-asparaginase with preeclampsia.

Protein S

A protein without which neither antithrombin nor protein C can work. The level can only decrease, which is determined with congenital protein S deficiency, liver disease, taking Warfarin and other anticoagulants.

norms of analysis in adults and children

Normal values ​​of hemostasiogram parameters

Most parameters of hemostasis differ only slightly between adults and young patients. A noticeable difference is typical for infants after childbirth up to 2 months of life.

Table of normal coagulogram indicators

up to 10 years 65 – 130%

under 16 years old 80 – 120%

When analyzing a coagulogram, it should be taken into account that reference values, methods and units of measurement may differ in individual laboratories.

Coagulogram during pregnancy

While waiting for the baby, the body experiences high loads and significant changes in hemostasis, which is determined by the development of the uteroplacental circulation in a pregnant woman.

The body during this period tries to protect itself with the likely development of placental abruption, uterine bleeding, and the formation of intravascular blood clots. A coagulogram helps to timely identify the threat of miscarriage, bleeding, negative effects on the function of the brain and other organs of the fetus.

With severe gestosis, a life-threatening complication can develop - DIC, which is first expressed in the occurrence of many small blood clots, impaired blood flow between the mother and fetus, and then in the failure of blood coagulation mechanisms (acoagulation). Such a pathological condition leads at the 1st stage to placental insufficiency, fetal hypoxia, to a high probability of blockage of the arteries of important organs, and later to the risk of massive bleeding and death of the pregnant woman and fetus.

Therefore, a woman, in anticipation of a baby, once a trimester (and in case of complications, more often) must undergo a hemostasiogram.

Indicators of hemostasis in pregnant women

Important! All of these standards are indicative, not unified. A competent interpretation of the coagulogram can only be performed by an obstetrician-gynecologist. It is strictly not recommended to use information from the Internet and advice from forums on the Internet.

Deciphering the hemostasiogram during pregnancy

Normally, in the first three months, blood coagulation parameters can be reduced, but by the end of pregnancy, on the contrary, they increase, as preparation for blood loss during childbirth takes place.

Probable anomalous conditions in case of deviation of hemostasis indicators from the norm

kidney disease, diabetes mellitus, thrombosis, oncology

If in the hemostasiogram 1 or 2 indicators have values ​​that deviate from the norm, this does not mean that the patient is immediately threatened with a serious complication. As a rule, this only indicates the adaptation of the mechanisms of hemostasis, which works in the mode that is currently necessary for the pregnant woman.

Really threatening pathologies are reflected in the coagulogram by a significant deviation from the norm of many indicators

Correctly and timely made hemostasiogram is the key to successful treatment of acquired and congenital diseases in the developmental stage and in the early stages, prevention of bleeding or, conversely, abnormal formation of blood clots. An analysis of blood clotting in women carrying a child will allow the doctor to prevent placental abruption, fetal underdevelopment due to vascular thrombosis, miscarriage, the development of preeclampsia, DIC, dangerous bleeding and death. But due to the complexity of the study, it is unacceptable to independently draw conclusions about the presence or absence of pathologies. Only a qualified specialist is able to conduct an accurate analysis and make a correct prediction.

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The material is published for informational purposes only and under no circumstances can be considered a substitute for medical advice from a specialist in a medical institution. The site administration is not responsible for the results of using the posted information. For diagnostics and treatment, as well as prescribing medications and determining the scheme for taking them, we recommend that you contact your doctor.

Update: December 2018

A coagulogram (otherwise a hemostasiogram) is a special study that shows how good or bad a person's blood coagulation is.

This analysis plays a very important role in determining a person's condition. Its indicators help to predict how the operation or childbirth will go, whether the patient will survive, whether it is possible to stop the bleeding of the wounded.

More about blood clotting

Blood is a special liquid that has the ability not only to circulate through the vessels, but also to form dense clots (blood clots). This quality allows her to close gaps in medium and small arteries and veins, sometimes even imperceptibly to humans. Preservation of the liquid state and blood clotting is regulated by the hemostasis system. The coagulation system or hemostasis system consists of three components:

• vascular cells, and specifically the inner layer (endothelium) - when the vessel wall is damaged or ruptured, a number of biologically active substances (nitric oxide, prostacyclin, thrombomodulin) are released from endothelial cells, which trigger thrombosis;
• platelets are platelets that are the first to rush to the site of injury. They stick together and try to close the wound (forming a primary hemostatic plug). If platelets cannot stop bleeding, plasma clotting factors turn on;
• plasma factors- the hemostasis system includes 15 factors (many are enzymes), which, due to a number of chemical reactions, form a dense fibrin clot that finally stops bleeding.

A feature of coagulation factors is that almost all of them are formed in the liver with the participation of vitamin K. Human hemostasis is also controlled by anticoagulant and fibrinolytic systems. Their main function is to prevent spontaneous thrombosis.

Indication for the appointment of a hemostasiogram

How to prepare for a coagulogram?

• the material is taken strictly on an empty stomach, it is desirable that the previous meal was at least 12 hours ago;
• on the eve it is recommended not to eat spicy, fatty, smoked foods, alcohol;
• it is forbidden to smoke before taking the material;
• it is advisable to stop taking anticoagulants of direct and indirect action, since their presence in the blood can distort the coagulation parameters;
• if the intake of such medications is vital for the patient, it is necessary to warn the laboratory assistant who will consider the analysis.

How is a blood coagulation test done?

• the material is taken with a dry sterile syringe or a Vacutainer vacuum blood collection system;
• blood sampling should be carried out with a needle with a wide lumen without the use of a tourniquet;
• vein puncture should be atraumatic, otherwise a lot of tissue thromboplastin will get into the test tube, which will distort the results;
• the laboratory assistant fills 2 test tubes with material, while sending only the second one for examination;
• the tube must contain a special coagulant (sodium citrate).

Where can I get tested?

This study can be carried out in any private or public clinic or laboratory that has the necessary reagents. Hemostasiogram is a difficult analysis to perform and requires sufficient qualification of laboratory assistants. The cost of the examination varies from 1000 to 3000 rubles, the price depends on the number of factors to be determined.

How many days is a coagulogram done?

To obtain the results of the study, the laboratory doctor usually conducts a series of chemical reactions that require a certain time. It usually takes 1-2 business days. One thing also depends on the workload of the laboratory, the availability of reagents, and the work of the courier.

Norm of coagulogram

Deciphering the coagulogram

Prothrombin time (PT)

PT is the time of thrombin clot formation if calcium and thromboplastin are added to the plasma. The indicator reflects the 1st and 2nd phase of plasma coagulation and the activity of 2,5,7 and 10 factors. Norms of prothrombin time (PT) at different ages:

• Newborn premature babies - 14-19 sec;
• Newborn full-term babies - 13-17 seconds;
• Young children - 13-16 sec;
• Older children - 12-16 seconds;
• Adults - 11-15 sec.

Therapy with anticoagulants is considered effective if the PT increases at least 1.5-2 times.

INR

INR or prothrombin coefficient is the ratio of the patient's PV to the PV of the control tube. This indicator was introduced by the World Health Organization in 1983 to streamline the work of laboratories, since each laboratory uses different thromboplastin reagents. The main purpose of determining the INR is to control the intake of indirect anticoagulants by patients.

Reasons for changes in PV and INR:

APTT (activated partial thrombin time, cephalin-kaolin time)

APTT is a measure of the effectiveness of plasma factors in stopping bleeding. In fact, APTT reflects the internal pathway of hemostasis, how quickly a fibrin clot forms. This is the most sensitive and accurate indicator of the hemostasiogram. The value of APTT, first of all, depends on the reagents-activators used by the doctor, and the indicator may vary in different laboratories. A shortening of the APTT indicates increased coagulability, the possibility of the formation of blood clots. And its lengthening indicates a decrease in hemostasis.

Why does the APTT value change?

Activated recalcification time

AVR is the time required for the formation of fibrin in plasma saturated with calcium and platelets. The indicator reflects how much the plasma and cellular parts of hemostasis interact with each other. Its value may vary depending on the reagents used in the laboratory. AVR lengthens with a decrease in the number of platelets (thrombocytopenia) and a change in their quality (thrombocytopathies), hemophilia. A shortening of the AVR indicates a tendency to form blood clots.

Prothrombin index

The prothrombin index or PTI is the ratio of the ideal prothrombin time to the patient's prothrombin time multiplied by 100%. Currently, this indicator is considered obsolete, instead, doctors recommend determining the INR. The indicator, like the INR, levels out those differences in the results of PT that occur due to different thromboplastin activity in different laboratories.

Under what pathologies does the indicator change?

thrombin time

Thrombin time shows the final stage of hemostasis. TB characterizes the length of time required for the formation of a fibrin clot in plasma if thrombin is added to it. It is always determined together with APTT and PT for the control of fibrinolytic and heparin therapy, the diagnosis of congenital pathologies of fibrinogen.

What diseases affect thrombin time?

fibrinogen

Fibrinogen is the first factor in blood clotting. This protein is formed in the liver and under the influence of the Hageman factor is converted into insoluble fibrin. Fibrinogen belongs to the acute phase proteins, its concentration increases in plasma during infections, trauma, and stress.

Why does the level of fibrinogen in the blood change?

RFMK

RFMK (soluble fibrin-monomer complexes) are intermediate products of fibrin clot breakdown due to fibrinolysis. RFMK is very quickly excreted from the blood plasma, the indicator is very difficult to determine. Its diagnostic value lies in the early diagnosis of DIC. Also RFMC increases with:

• thrombosis of various localization (thromboembolism of the pulmonary artery, deep veins of the extremities);
• in the postoperative period;
• complications of pregnancy (preeclampsia, preeclampsia);
• acute and chronic renal failure;
• sepsis;
• shocks;
• systemic connective tissue pathologies and others.

Antithrombin III

Antithrombin III is a physiological anticoagulant. Structurally, it is a glycoprotein that inhibits thrombin and a number of coagulation factors (9,10,12). The main site of its synthesis is the liver cells. Indicators of antithrombin III at different ages:

• Newborns - 40-80%
• Children under 10 years old - 60-100%
• Children from 10 to 16 years old - 80-120%
• Adults - 75-125%.

Why does its content in the blood change?

D-dimer

D-dimer is the residue of split fibrin strands. This indicator reflects both the work of the coagulation system (if there is a lot of D-dimer in the blood, it means that a lot of fibrin has been split) and the function of the anticoagulant system. The indicator is contained in the blood for about 6 hours after formation, so the material must be immediately examined in the laboratory.

Diagnostic value is only an increase in the level of the indicator, which occurs when:

• thrombosis and thromboembolism of arteries and veins;
• liver diseases;
• extensive hematomas;
• ischemic heart disease and myocardial infarction;
• in the postoperative period;
• prolonged smoking;
• DIC;
• seropositive rheumatoid arthritis.

Bleeding time

Method of determination: pierces the earlobe with a medical needle or a scarifier. Then we note the time until the blood stops. Doctors evaluate only the lengthening of the indicator, since its shortening indicates an incorrectly conducted study. Bleeding time is lengthened due to:

• lack of platelets in the blood (thrombocytopenia);
• hemophilia A, B and C;
• liver damage from alcohol;
• hemorrhagic fevers (Crimea-Congo, with renal syndrome);
• thrombocytopenia and thrombocytopathy;
• overdose of indirect anticoagulants and anticoagulants.

Blood clotting time according to Lee-White and Mass and Magro

This study shows the time required for the formation of a blood clot. The method is very simple to perform: blood is taken from a vein. The material is poured into a dry, sterile tube. The time is recorded until a blood clot visible to the eye appears. In violation of the hemostatic system, the clotting time can be shortened and lengthened. In some pathological conditions (DIC, hemophilia), a clot may not form at all.

Coagulogram during pregnancy

During pregnancy, a woman's body undergoes colossal changes that affect all systems, including the hemostasis system. These changes are due to the appearance of an additional circle of blood circulation (uteroplacental) and a change in hormonal status (prevalence over estrogens).

During the period of bearing a child, the activity of coagulation factors increases, especially 7,8,10 and fibrinogen. There is a deposition of fibrin fragments on the walls of the vessels of the placental-uterine system. The fibrinolysis system is suppressed. Thus, the woman's body tries to insure itself in the event of uterine bleeding and miscarriage, prevents placental abruption and the formation of intravascular blood clots.

Indicators of hemostasis during pregnancy

In pathological pregnancy (early and late gestosis), disturbances in the regulation of blood coagulation occur. The life of platelets is shortened, fibrinolytic activity increases. If a woman does not go to the doctor and does not treat gestosis, a very formidable complication occurs - DIC.

DIC or disseminated intravascular coagulation syndrome consists of 3 stages:

• hypercoagulation- the formation of many small blood clots, impaired blood circulation between the mother and fetus;
• hypocoagulation - over time, clotting factors are depleted in the blood, blood clots disintegrate;
• acoagulation - lack of blood clotting, uterine bleeding occurs, which threatens the life of the mother, the fetus in most cases dies.

A coagulogram is the result of a comprehensive laboratory study of the blood coagulation system (hemostasis). The information obtained is drawn up in the form of a table or graph, after which it is transferred to a specialized specialist for further study, correction and diagnosis. In modern laboratories, many coagulological tests are carried out, which indicate the functionality of the entire coagulation cascade and its individual parts. Why take a blood test for a coagulogram, how to properly prepare for the study and decipher the results?

General characteristics of the method

All modern laboratories offer patients comprehensive blood tests. One of these studies is a coagulogram. This is a set of blood parameters that help evaluate the functionality of hemostasis. Hemostasis is the biological system of our body. It is responsible for maintaining the liquid state of the blood, creating / dissolving blood clots and stopping bleeding. Physicians use venous blood as a material for research. Its study provides information about the degree of blood clotting, the risk of developing a blood clot or internal bleeding.

Each of us at least once could observe the functionality of hemostasis. For example, if a finger / any other part of the body is damaged, a bleeding wound forms on the surface of the skin. The appearance of a wound turns on the blood coagulation system and makes it work with a vengeance. The body stops bleeding on its own (if it is insignificant) and forms a thrombus that closes the damage in the vascular wall. The better and more intensively hemostasis works, the faster tissues can regenerate, and the person can return to the usual rhythm of life.

The blood clotting system is also responsible for menstruation in women, placental abruption after childbirth, and any damage to the blood vessels of the human body. Its functionality can be broken in both directions. With excessive work of hemostasis, too many blood clots form in the body, which clog the vessels and lead to heart attacks, strokes, and thrombosis. Insufficient activity of hemostasis is fraught with increased bleeding, a tendency to bruising, and prolonged regeneration. To assess the functionality of the system, possible risks for the patient and determine the correction of violations, a coagulogram is used.

The analysis is prescribed for both therapeutic and prophylactic purposes. Contact your general practitioner for advice and to determine the appropriateness of the study.

Indications for a coagulogram

The study is prescribed in such cases:

• frequent bleeding;
• the formation of bruises even with minimal tissue trauma;
• preparation for surgery (to assess the possible risks of surgery);
• pathology of the liver, cardiovascular system (for the preparation of a therapeutic course and the selection of medicines);
• violation of the protective function of the immune system (to study the possible causes of the disease);
• pregnancy (monitoring the condition of the mother and child).

Study indicators

A coagulogram is a whole complex of various studies of the blood coagulation system, which give an idea of ​​​​its work. According to the number of indicators required for the study, there are 2 types of coagulogram - standard and extended. A standard analysis is prescribed for general health monitoring, but an extended one is necessary during pregnancy, before surgery, to evaluate the effectiveness of therapy.

Venous blood is placed in a test tube with a specific anticoagulant. It prevents blood from clotting and allows you to study the specific reactions of the fluid. If any indicators of the coagulogram are outside the norm, the specialist monitors the stage at which the violation occurred and proceeds to its detailed study. Each indicator of the state of the blood is closely related to the next. It is this connection that helps to track the norms / pathologies of the coagulation system.

The main parameters of the coagulogram include:

1. Prothrombin time and its derivatives. These are laboratory indicators that evaluate the external pathway of blood clotting. They help determine the effectiveness of warfarin therapy, the degree of impaired liver function, and saturation of the body.
2. Activated partial thromboplastin time. A measure of the effectiveness of the intrinsic and common clotting pathway. Helps evaluate the effectiveness of anticoagulant therapy. Always used in combination with prothrombin time test results.
3. thrombin time. Reflects violations of the final stage of coagulation. Measures the rate of conversion of fibrinogen to fibrin by examining citrated blood plasma.
4. fibrinogen. A colorless protein that is found dissolved in blood plasma. As soon as bleeding opens in the body, regardless of intensity, the protein undergoes cleavage by thrombin and turns into fibrin. Fibrinogen is produced in the liver and eventually turns into a clot, completing blood clotting.

How to prepare for material collection?

The material for the study is venous blood. To get the most accurate result, the patient must adhere to specific preparation rules. They cannot be ignored, because the price of an erroneous analysis can be a human life. The first and most important rule is that blood is taken on an empty stomach. Approximately 12 hours before the test, the patient should stop eating food. It is forbidden to drink alcohol-containing or energy drinks 24 hours before material sampling. The ban even applies to tea, coffee and freshly squeezed juices. The patient can drink only filtered water, which will not affect the composition and functions of the blood.

On the eve of the sampling of the material, it is impossible to expose the body to stress. Give up training in the gym, hard work or a long showdown. Take a day off or try to relax as much as possible at your usual pace. Medications should also be discontinued before starting the study. Does your body need medication to keep you alive? Notify your doctor in advance. He will assess the situation and determine the appropriateness of the coagulogram.

If you feel headache, dizziness, general weakness before / during blood sampling, be sure to notify the medical staff about this.

Is it necessary to take a coagulogram for children and pregnant women?

Yes, children and pregnant women may be prescribed a blood coagulation test. A referral for analysis is issued by a specialized doctor, if necessary. To determine the hemostasis of the child's body, the parameters included in the standard coagulogram will be quite enough. Pregnant women need enhanced health monitoring, so they are prescribed an extended coagulogram.

Blood testing during pregnancy is a standard mandatory practice for every woman. A coagulogram is necessary both in the normal course of pregnancy and in the presence of pathologies. During the development of the fetus, blood counts can change significantly. The differences between hemostasis during the first trimester and a few weeks before delivery are enormous. So the body prepares for future stress, large blood loss during childbirth and subsequent recovery.

Deciphering coagulogram analyzes during pregnancy

The volume of circulating blood in the body of a pregnant woman increases by about 20-30%. This contributes to the filling of the placenta and fetus with blood. In fact, the female body performs the blood supply to two different organisms - mother and child, which secrete a certain amount of fluid. An increase in blood concentration is certainly associated with an increase in the level of substances of the coagulation and anticoagulation system. Their number and activity normally increases by 15-30%.

It is important to understand that a coagulogram is prescribed for pregnant women in order to track the risk of thrombosis and conditions that can harm the mother and baby. Among them are placental abruption, intrauterine fetal death, miscarriage, preeclampsia. The study does not carry any other information (for example, about diseases of specific organs). Any infections and inflammations in the mother's body must be stopped before pregnancy, as they can lead to the death of both the woman and the baby.

If one or two indicators of the coagulogram of a pregnant woman are outside the norm, this does not indicate placental abruption or a threatened miscarriage. On the contrary, the system works in the mode that it needs and does not indicate the presence of severe pathology. You should only worry about the condition of a pregnant woman if all coagulogram indicators are above or below normal.

Izvozchikova Nina Vladislavovna

Speciality: infectious disease specialist, gastroenterologist, pulmonologist.

General experience: 35 years .

Education:1975-1982, 1MMI, San-Gig, highest qualification, infectious diseases doctor.

Science degree: doctor of the highest category, candidate of medical sciences.