Interpretation of thromboelastogram teg 5000 is normal. If the thromboelastogram is not normal: treatment methods

A thromboelastogram is a record of the results of a blood test (thromboelastography). It was developed in the middle of the last century as a method for determining the viscoelastic characteristics of fibrin from a blood sample, or more simply, its viscosity. At first the technology caught on, but over time it was almost abandoned. This happened because due to the imperfection of the equipment and the use of reusable cuvettes, the reliability of the results periodically suffered. The test was recently revived.

What is thromboelastogram

This medical term refers to a document containing the results of thromboelastography - a study that allows you to track all stages of changes in blood viscosity.

Synonyms for the name of the procedure and its results: TEG, thromboelastometry (when it comes to checking hemostasis).

Based on the data obtained, a graph is constructed reflecting the phases of the process:

1. The first, which lasts from 4 to 10 minutes, during which a reaction occurs that stimulates the production of thrombokinase. An organic substance with this name is formed in the early stages of coagulation. It works as an enzyme and helps convert inactive prothrombin into active thrombin.
2. The second, the duration of which is from 5 to 8 minutes. During this period, the formation of a clot and, at the same time, the main element that causes clotting, thrombin, occurs.
3. The third, reflecting the stage of formation of fibrin - an insoluble fibrous protein that takes part in coagulation (folding). In this phase, the graph curve gains maximum amplitude.

What does it show

TEG makes it possible to evaluate the physical characteristics of a blood clot, the dynamics of hemostasis, and also detect:

• hyperfibrinolysis - excess of the enzyme plasmin, indicating an increased risk of bleeding;
• hypofibrinolysis, meaning a tendency to pathological thrombus formation.

When and to whom is it prescribed?

Doctors use TEG when it is necessary to assess the functionality of the blood clotting system. This happens frequently and affects almost all areas of medicine. Knowledge of hemostasis parameters is especially important when it comes to the prevention and treatment of conditions associated with its disorders:

• in surgery and hematology;
• obstetrics and gynecology;
• cardiology and neurology;
• oncology and other areas.

TEG makes it possible to track the activity of both plasma and cellular elements of hemostasis in their actual concentration.

The results of the analysis make it possible not only to predict, for example, an increased risk of thrombosis, but also:

• adjust the therapy of cardiovascular diseases with the maximum probability of a favorable outcome;
• promptly detect the risk of high blood loss when it comes to surgery. In addition, a TEG test on the eve of surgery makes it possible to minimize the need for donor plasma.

And that's not it. There are special algorithms for transfusion of blood components based on thromboelastogram data. They are used to stop bleeding after injuries and large-scale surgical operations. The TEG diagnostic method allows for more accurate use of donor blood components and does not use drugs that are potentially dangerous due to their side effects to restore hemostasis.

Interpretation of information obtained from TEG results makes it possible to select a regimen and dose of drugs for the treatment of patients with abnormal platelet aggregation. This is important because excess activity of these blood components causes blockage of blood vessels and can cause death.

Assessment of hemostasis is necessary periodically and during pregnancy, when clotting problems can pose a real danger to the life of the woman and the fetus. In this case, the usual one is not enough.

Preparing for analysis

Blood donation for a TEG test is prescribed in the morning, on an empty stomach. It is advisable that the last meal the day before should be at least 8 hours before. In emergency situations, the analysis is carried out regardless of the time of day and the previous meal.

One day before going to the clinic, you must stop smoking, avoid emotional and physical stress, and three days before, do not drink alcohol.

How to do it

For thromboelastography, blood is taken from a vein on the inside of the elbow, as for a regular analysis. The nurse immediately delivers the test tube with the biomaterial to the laboratory.

There, blood stabilized with sodium citrate is transfused into a disposable cuvette, a metal cylinder is inserted, and then the whole thing is placed in a special device - a thromboelastograph. To monitor reactions to heparin drugs, a heparinase cuvette is used.

After turning on the apparatus, the cuvette begins to move and begins to oscillate. At this time, the blood coagulates and sticks as a clot to the walls of the container and cylinder, located between them.

As the “thrombus” compacts, the vibration range increases, and the rotations of the cylinder are continuously recorded on paper or electronic media. When the clot is fully formed, the amplitude becomes maximum. Then the reverse process begins - the dissolution of the “thrombus”, as the oscillations slowly decrease, and all changes are also reflected on the TEG graph.

What do thromboelastogram parameters mean: table

Analysis results are ready after 40–60 minutes. In emergency situations, a rapid TEG analysis is performed, which allows obtaining information within 5 minutes.

What may affect the results

Digital thromboelastogram indicators may change due to electrolyte disturbances in the body, taking medications that affect blood composition, as well as due to recent surgery/trauma and the course of existing pathologies.

Even age and gender can affect the main parameters of TEG. As you grow older, the MA value may increase, and the K value may become smaller. A likely explanation for this is an increase in fibrinogen levels. A tendency towards an increase in MA in women has been noted, which is due to a decreased hematocrit - the ratio of red blood cell mass to total blood volume.

Fibrinogen levels in human blood and what to do if it is elevated:

Decoding the results

Only a doctor can correctly interpret the data obtained using a TEG test, that is, understand and explain the picture of hemostasis based on the obtained figures. It is impossible to do this on your own without higher medical education. However, there are indicators that mean that a particular parameter is within normal limits.

TEG norms and deviations: table

Despite the high diagnostic value of the results, the thromboelastography method is considered inaccurate, since it allows you to get an approximate picture, but does not give an unambiguous answer about the pathologies that caused the deviations. To make a final diagnosis, the results of TEG are considered in conjunction with other data obtained during diagnostic procedures.

Advantages and disadvantages of the method

The significant advantages of TEG include the ability to:

• use whole blood for research rather than isolating its plasma. This saves time, which is very important in urgent cases;
• recognize the real and important value - the strength of the clot, and not conventional indicators (for example, optical), which do not always provide reliable information;
• identify problems of different elements involved in hemostasis.

The disadvantages are:

• inability to evaluate the process of thrombin formation;
• difficulties of simultaneous analysis of several blood samples.

For example, coagulometers determine indicators using the conveyor principle, processing a large number of samples at once and spending seconds on each of them. In contrast, TEG lasts a long time, and the vast majority of thromboelastograph models have no more than 2 cuvettes.

Where is the test usually taken?

The thromboelastography test is done in medical and diagnostic institutions where there is appropriate equipment and specialists, including those who can interpret the results.

If we talk about public clinics, then these will most likely be hospitals and large diagnostic centers. There, the study can be obtained free of charge, with the direction of the attending physician. It is possible that the wait for an appointment will be long, several months.

The opportunity to do TEG immediately, but for money, is available in private clinics. As for the average prices for the procedure, it varies in different regions of Russia.

When choosing a clinic, you should keep in mind that the pricing mechanism is not the same. In some cases, the cost of the analysis includes a full set of services, and sometimes even a consultation with a hematologist. In others, the process of drawing blood is paid separately from the analysis and subsequent interpretation of the results. In addition, conventional thromboelastography and tests for aspirin, Plavix and other compounds will cost differently.

Is the use of Aspirin justified to reduce blood viscosity:

Prices in different regions

According to information from clinics posted on their official websites, the average price of a standard TEG as of November 2018 is:

• in Moscow - 6,000 rubles;
• in St. Petersburg - 1300 rubles;
• in Yekaterinburg - 2200 rubles;
• in Krasnodar - 2500 rubles.

Private medical institutions periodically hold promotions that allow you to get tested or get specialist advice at a lower price than usual.

Thromboelastography (thrombo- + Greek elastos – viscous + grapho write, depict) – graphic registration of spontaneous coagulation of venous blood using a thromboelastograph. The method was first proposed by H. Hartert in 1948. The principle of the thromboelastography method is to assess the viscoelastic properties of blood during its coagulation. The method makes it possible to record blood coagulation and changes in blood clot elasticity over time (retraction and lysis) and, thereby, evaluate clot formation from initial procoagulant activation and fibrin formation to clot lysis. For graphical recording of the processes of blood coagulation and fibrinolysis, devices are used - thromboelastographs (ARP-01M Mednord (Russia), TEG-500 (USA)). The main part of the thromboelastograph is the cuvette into which blood is added (Fig. 3).

Rice. 3. Thromboelastography process.

A rod with a disk or plate at the end that does not touch its walls is immersed in the cuvette. A special device imparts oscillatory-rotational movements to the cuvette, which are transmitted to the rod and recording device only when fibrin filaments begin to form in the cuvette with blood. As the clot is formed and compacted, the amplitude of the rod's vibrations increases and reaches a maximum. Graphic registration of the vibration amplitude of the rod allows you to obtain thromboelastogram (Fig. 4).

Rice. 4. Thromboelastogram is normal.

To evaluate the thromboelastogram, 5 main quantitative indicators are used:

1. Reaction time (R) – time from the start of the study to the start of blood clotting (the first deviation of the thromboelastogram from a straight line by 1 mm);

2. Coagulation time (K) – the time from the beginning of movement of the device rod (1 mm) until the moment when the amplitude of the thromboelastogram is 20 mm.

3. R+K – coagulation rate; is an important indicator for recognizing prethrombotic conditions;

4. Maximum amplitude (MA) of the thromboelastogram;

5. E – maximum elasticity of the clot, calculated from the maximum amplitude of the thromboelastogram MA: E = (100 x MA) F: (100 – MA).

Interpretation:

Time R characterizes the following phases of blood coagulation: 1) formation of thromboplastin; 2) fibrin formation.

The E value reflects the functional ability of platelets, the quantity and quality of fibrinogen.

Normal values ​​are established empirically for each device. On average, in healthy people:

Reaction time (R) ̴ 9-14 min.

Coagulation time (K) ̴5-8 min.

MA ̴ 48-52 mm.

Clinical and diagnostic value of thromboelastography. Allows the doctor to quickly and fully assess all aspects of the patient’s blood coagulation system. Using this method, it is possible to identify early signs of hypercoagulation and hypocoagulation caused by a deficiency of blood coagulation factors, diagnose platelet dysfunction, as well as evaluate the effectiveness of anticoagulant and antiplatelet therapy, evaluate the fibrinolytic activity of blood plasma and the advisability of prescribing antifibrinolytic therapy. Typical changes in thromboelastogram during hypo- and hypercoagulation are shown in Fig. 5.

Rice. 5. Thromboelastogram is normal (a), with hypercoagulation (b) and hypocoagulation (c). Patients with hypercoagulation are characterized by a shortening of R and K, as well as an increase in MA; in the presence of hypocoagulation, a lengthening of R, K and a decrease in MA are detected. A prethrombotic state is indicated by a decrease in the constant (R+K) of less than 14 minutes and an increase in MA of more than 52 mm.

The main advantage of thromboelastography is its high sensitivity, speed of obtaining results (in 1-1.5 hours), the ability to change the mechanical properties, fibrinolytic structure of the clot, as well as assess the fibrinolytic system.

Annex 1.

COAGULOGRAM – a set of tests characterizing the functional state of the coagulation and anticoagulation systems of the blood. A complete set of coagulogram includes from 7 to 20 tests, the choice of which depends on many conditions with mandatory consideration of the results of the patient’s clinical examination.

§ Level 1 Assessment Tests – performed in the primary care clinical laboratory: platelet count, bleeding time, APTT, PT (INR), fibrinogen amount using the Claus method.

§ Level 2 Assessment Tests – performed in laboratories of diagnostic centers and hospitals: platelet aggregation, TV, D-dimer (or RFMK), euglobulin lysis.

§ Additional tests – performed in specialized laboratories:
- for bleeding - activity of von Willebrand factor of plasma coagulation factors (VIII, IX, XI, VII, X, V, II, HMWK, PK);

- with a tendency to thrombosis - antithrombin, proteins C and S, aPC resistance, homocysteine, lupus anticoagulant, antiphospholipid antibodies, genetic testing ( FV Leiden C1691Ab prothrombin gene mutation G20210A).

Thank you

The site provides reference information for informational purposes only. Diagnosis and treatment of diseases must be carried out under the supervision of a specialist. All drugs have contraindications. Consultation with a specialist is required!

What is a coagulogram?

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

Disturbances in the functioning of the coagulation system can occur not only by the type of its insufficient activity, but also by its excessive activity. If the coagulation system is insufficiently active, a person develops bleeding, a tendency to bruise, long-term unstoppable bleeding from a small wound on the skin, etc. And with excessive activity of the coagulation system, on the contrary, a large number of blood clots are formed, which clog the blood vessels and can cause heart attacks, strokes, thrombosis, etc.

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

Coagulogram indicators

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

Each coagulogram indicator reflects the course of the first, second or third stage of blood clotting. At the first stage, the blood vessel spasms, that is, it narrows as much as possible, which minimizes the amount of damage. At the second stage, blood platelets “stick together” (aggregate) and form a loose and large clot that seals the hole in the blood vessel. At the third stage, a kind of mesh is formed from threads of the dense fibrin protein, which cover the loose mass of sticky platelets and tightly fix it to the edges of the hole on the vessel wall. Then the mass of sticky platelets compacts and fills the cells between the fibrin fibers, forming a single elastic and very strong “patch” (thrombus), which completely closes the hole in the wall of the blood vessel. This is where blood clotting ends.

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

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

1. First stage indicators formation of prothrombinase):

• Lee-White blood clotting time;
• Contact activation index;
• Plasma recalcification time (PRT);
• Activated recalcification time (AVR);
• Activated partial thromboplastin time (APTT, APTT, ARTT);
• Prothrombin consumption;
• Factor VIII activity;
• Factor IX activity;
• Factor X activity;
• Factor XI activity;
• Factor XII activity.

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

• Thrombin time;
• Fibrinogen concentration;
• Concentration of soluble fibrin-monomer complexes.

In addition to these indicators, in an analysis called a “coagulogram”, laboratories and doctors often include other indicators that reflect the functioning of another system, which is called anticoagulant (fibrinolytic). Anticoagulant system has the opposite effect of coagulation, that is, it dissolves blood clots and inhibits the blood clotting process. Normally, these systems are in dynamic equilibrium, neutralizing each other’s effects and ensuring blood clotting when needed and dissolution of the clot if it is formed accidentally.

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

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

The work of the fibrinolytic system is assessed by the following indicators which are included in the coagulogram:

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

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

• Fibrinogen;
• Thrombin time (TV).

The extended coagulogram includes the following indicators:

• Prothrombin in % according to Quick or prothrombin index;
• International normalized ratio (INR);
• Fibrinogen;
• Activated partial thromboplastin time (aPTT);
• Thrombin time (TV);
• Antithrombin III;
• D-dimer.

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

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

What coagulogram parameters are needed for children and pregnant women?

Coagulogram parameters and their values ​​are normal

Decoding the coagulogram

Lee-White clotting time

Plasma recalcification time (PRT)

Activated recalcification time (ATR)

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

Activated partial thromboplastin time (APTT, APTT, ARTT)

Prolongation of APTT is typical for the following diseases:

• von Willebrand's disease;
• Deficiency of coagulation factors (II, V, VII, VIII, IX, X, XI, XII);
• Congenital deficiency of prekalykrein and kinin;
• Administration of heparin or streptokinase;
• Taking anticoagulants (Warfarin, Sincumarin, etc.);
• Vitamin K deficiency;
• Low levels of fibrinogen in the blood;
• Liver diseases;
• II and III phases of DIC syndrome;
• Condition after a large volume of blood transfusion;
• Presence of lupus anticoagulant in the blood;
• Antiphospholipid syndrome;
• Chronic glomerulonephritis;
• Systemic lupus erythematosus;
• Connective tissue diseases.

• Acute blood loss;
• Initial stage of DIC syndrome.

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

Prothrombin time (PT, RT, recombipl RT)

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

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

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

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

Prothrombin index (PTI)

International normalized ratio (INR)

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

Prothrombin according to Duke

An increase in the Duke prothrombin percentage above normal occurs under the same conditions as a shortening of prothrombin time. A decrease in the Duke prothrombin percentage below normal occurs under the same conditions as an increase in prothrombin time.

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

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

PTI and Duke prothrombin are calculated in diagnostic coagulograms, which people take before operations, during preventive examinations, or examinations for any symptoms. INR is calculated when monitoring and selecting the dosage of anticoagulants (Aspirin, Warfarin, Thrombostop, etc.). Prothrombin time, as a rule, is indicated in coagulograms necessary to identify diseases of the blood coagulation system.

Thrombin time (TV, TT)

An increase in thrombin time reflects a decrease in blood clotting and is observed in the following conditions:

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

• Use of heparin;
• The first stage of DIC syndrome.

Fibrinogen concentration (fibrinogen, Fib)

• Myocardial infarction;
• Injuries;
• Burns;
• Nephrotic syndrome;
• Multiple myeloma;
• Inflammatory diseases that last a long time;
• Pregnancy;
• Taking estrogen-containing oral contraceptives (Marvelon, Mercilon, Qlaira, etc.);
• Condition after surgery.

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

Soluble fibrin-monomer complexes (SFMC)

Lupus anticoagulant

D-dimers

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

• DIC syndrome (first phase);
• Myocardial infarction;
• Thrombosis of arteries or veins;
• Infectious diseases;
• Acute or chronic inflammatory diseases;
• Gestosis during pregnancy;
• Large hematomas;
• The presence of rheumatoid factor in the blood;
• Condition after surgery;
• Age over 80 years;
• Malignant tumors of any location;
• Use of tissue plasminogen activator.

Protein C

• Congenital protein C deficiency;
• Liver diseases;
• The first stage of development of DIC syndrome.

Antithrombin III

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

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

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

Protein S

Decoding the coagulogram during pregnancy

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

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

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

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

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

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

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

Instrumental methods for studying the RAS system play an important role in the arsenal of methods due to their reliability and reliability, attracting special attention from clinicians due to the exceptional capabilities of rapid assessment of the functional state and the nature of the interaction of its constituent parts, the ease of performing research and their cost-effectiveness.
At the same time, the overwhelming number of methods, despite their widespread use in clinical practice, are characterized by low information content and high cost.

Thromboelastography, considered by clinicians to be the “gold standard”, regardless of the registration method, essentially determines four indicators: two chronometric (r, k) and two structural (MA, FA), does not provide dynamic monitoring of the functional state of the vascular-platelet, coagulation and fibrinolytic links of the system. It should also be noted that thromboelastography requires expensive chemical reagents. This not only increases the cost of the study itself, but also makes it impossible to compare the results obtained between medical institutions using different reagents.

Obviously, the development of new methods for studying the RAS system is an urgent problem for clinical medicine.

The company offers a Russian-made thromboelastograph. Due to the fact that within the framework of the healthcare modernization program, special emphasis is placed on replacing imported medical equipment, the issue of comparison (Russia) and rotational thromboelastographs becomes relevant. TEG-5000(USA) and ROTEM(Germany).

For ease of comparison, here is a table of measured indicators:

As we can see from the table above, thromboelastrograph TEG 5000 Made in the USA, when working with whole blood, it measures the following indicators:

• r- time of contact coagulation;
• k- the main indicator characterizing the time of onset of clot formation;
• MA- maximum density of the clot;
• FA (IRLS)- intensity of clot retraction and lysis.

In turn, the hardware and software complex ARP-01M “Mednord” provides the following indicators on the computer screen in the form of a graphic image:

Figure 1 shows a graph of blood NPGC healthy volunteer.

Picture 1

Patient schedule with hypercoagulability And hypocoagulation

Figure 2

• k- the main indicator characterizing the time of onset of clot formation depends on the concentration of the thrombin formed, the antithrombin potential of the blood, the concentration and functional usefulness of fibrinogen, and factors of the prothrombin complex.
• IKK -intensity of the contact phase of coagulation. An indicator characterizing the intensity of the CKKK blood reaction, prothrombin activity, aggregation activity of platelets and other blood cells.
• KTA -thrombin activity constant,characterizes the rate of increase in thrombin formation, the intensity of the proteolytic stage of clot formation.
• VSK -blood clotting time.
• ICD -the intensity of the coagulation drive is an indicator characterizing the integrative influence of pro- and anticoagulation systems on the process (speed) of clot formation.
• IPS -intensity of clot polymerization - an indicator characterizing the speed of connection of monomer molecules “side-to-side”, “end-to-end”, forming a fibrin network with the peptide formula (?,?,?)n(F-P)
• MA -an indicator reflecting the aggregate state of blood in the final, stabilizing stage of thrombus formation. Reflects the completion of hemostasis by the formation of covalent bonds under the influence ofXIIIF., characterizes the structural rheological properties of the clot (viscosity, density, plasticity).
• T -time of formation of the F-T-C clot (total time constant for blood clotting).
• IRLS -intensity of clot retraction and lysis. An indicator characterizing spontaneous clot lysis. Reflects the intensity of the continuous hemocoagulation process (HCP), the state of plasmin activity, the amount of plasminogen structured into a clot, the degree of lability of plasminogen activators

Method of low-frequency piezothromboelastography using a thromboelastograph ARP-01M "Mednord" unlike rotational thromboelastographs TEG 5000 and ROTEM, which record only the final stages of blood coagulation, it is intended for a comprehensive assessment of the state and functional interaction of all parts of the hemostasis and fibrinolysis system, as well as for monitoring the effectiveness of targeted therapy for hemostasis disorders.

An undeniable advantage ARP-01M “Mednord” is the ability to monitor anticoagulant therapy in real time. ARP-01M "Mednord" allows for research without the use of reagents and reagents in an express laboratory, intensive care unit, operating room, in Pont-of-care-test mode at the patient’s bedside and obtain the necessary indicators from the first second of the study.

An important advantage is the lack of ARP-01M "Mednord" lag-time, while the lag-time for rotational thromboelastographs lasts up to 10 minutes. This advantage allows analysis to be carried out in the intensive care unit at the patient's bedside without special laboratory conditions. Also, to conduct research there is no need for sample preparation, since ARP-01M "Mednord" works with whole blood without the use of reagents or reagents.

In addition, the use of hardware and software complex ARP-01M “Mednord” It is feasible and economical, since the device is cheaper than foreign analogues and does not require the use of chemicals and reagents for research. In the current unstable financial situation, the purchase of consumables is becoming an unbearable burden for medical institutions. It should be noted that when using different chemical reagents it is impossible to conduct a comparative analysis of the obtained readings. When working with ARP-01M “MEDNORD”, such a problem does not arise and it is possible to conduct joint research by various medical institutions and specialists, since all the data obtained is validated.

Distinctive consumer characteristics of the ARP-01M Mednord complex:

• low cost compared to competitors
• work with whole blood without the use of reagents and reagents
• no lag time
• Russian production
• comprehensive assessment of all parts of hemostasis
• high information content
• standardization of the obtained data by creating a common database
• the possibility of consulting and analyzing the results obtained via the Internet
• compactness, simplicity and reliability in operation, low power consumption
• does not require special laboratory conditions and additional equipment; can work in the operating room, in the ward at the patient's bedside
• One study requires a small amount of test material (0.5 ml of blood).

Complex ARP-01M “Mednord”will significantly improve the quality of diagnosis and forecast the development of cardiovascular diseases, significantly reduce the costs of federal and regional budgets for the treatment of patients with CVD (due to timely detection and correct therapy), and also significantly reduce the mortality rate of the population.