One of the most important methods of maintaining a constant internal environment of the body is the blood clotting system. Despite their apparent strength, our blood vessels are quite often susceptible to damage during various movements. A person does not notice this only because of active blood clotting, which effectively prevents the development of bleeding. And with various kinds of disturbances in the functioning of this protective system of the body, numerous pathological processes arise. Therefore, to study the operation of this important mechanism, a method was developed that allows one to obtain data on all components of the coagulation system. The combination of these indicators is called a coagulogram.

It is quite simple to determine or diagnose a blood clotting disorder based on characteristic symptoms (bleeding gums, a large number of subcutaneous hemorrhages, bleeding in joint cavities) or using direct methods for determining coagulation - Mas-Magro or Morawitz tests. However, the process of formation of a blood clot is a complex multi-stage process in which dozens of compounds are involved and it is impossible to determine in this way at what stage the disturbances occurred. For this reason, a method for determining the coagulogram was developed, which makes it possible to study all stages and the most important components of this complex reaction.

The analysis itself consists of many biochemical studies aimed at studying both the entire hemostatic system as a whole and its individual components. Given the enormous importance of this research, it is constantly being improved, thanks to which its results become more accurate every year.

Preparation for the procedure and blood sampling technique

Taking into account the significant complexity of the method for determining a coagulogram, this analysis is done within the framework of fairly strict indications:

1. On the eve of extensive surgical interventions, each operation represents a wound to the body with bleeding, so it is extremely important for the surgeon to know the state of the patient’s blood coagulation system. In addition, after some surgical procedures, the administration of anticoagulants - substances that reduce clotting - is required to prevent the formation of blood clots. To calculate the dose of such drugs, you need to know exactly the level of activity of a person’s own hemostatic system.
2. If there are symptoms of increased bleeding - bleeding from the gums and nose, causeless subcutaneous hemorrhages.
3. In severe toxicosis of pregnant women, some forms of gestosis are manifested by sudden disturbances and fluctuations in the functioning of the coagulation system - from severe bleeding to massive formation of blood clots (DIC syndrome).
4. In a number of autoimmune diseases, one of the symptoms of such pathologies is the destruction of platelets, which play a key role in the functioning of the hemostatic system.
5. When taking medications that directly or indirectly affect coagulation processes - acetylsalicylic acid, heparin, hormonal drugs.
6. In case of disruption of the functioning of the organs that control the hemostatic system - primarily the liver, spleen, bone marrow, heart and blood vessels.

Shortly before donating blood to determine a coagulogram, you should not drink caffeine or alcohol. Smoking should be avoided approximately two hours before blood sampling. You should also relax and not expose your nervous system to stress. Immediately before the test, you should drink a glass of still water - this will increase the accuracy of the analysis.

Blood is taken from the cubital vein in an amount of 10-15 ml. Determination of the first indicators begins almost immediately after blood sampling.

Decoding the analysis results

Taking into account the fact that dozens of biochemical studies are performed in the process of determining the coagulogram, to facilitate diagnosis, a number of indicators have been identified that simply indicate a coagulation disorder and say little about the causes of this phenomenon. Currently, a special separate analysis is being carried out that studies precisely these criteria - it is called the basic coagulogram. In contrast, an extended coagulogram is performed when there is a confirmed violation of the hemostatic system and can determine its cause.

Deciphering a coagulogram, especially in combination with other diagnostic methods, makes it possible to easily determine the cause of a blood clotting disorder. Thanks to this, the doctor can prescribe correct and adequate treatment. Below is a table of extended coagulogram indicators, the criteria included in the basic study are highlighted in italics:

A special feature of this analysis is the presence of a large number of percentage indicators. This is observed due to the peculiarities of studying the blood coagulation system and its components - many of them are enzymes, the activity of which was measured by biochemical methods in research laboratories. Having determined the standard of such activity, the indicator of the hemostatic system is compared with it, and the obtained data is displayed as a percentage.

Brief characteristics of coagulogram indicators

First phase of blood clotting

It is produced in special test tubes, and the rate of this indicator depends on the material of the container. This criterion reflects the rate of formation of a blood clot.

is the ratio of the rate of blood clotting in silicone and glass tubes. This ratio reflects the activity of some factors of the hemostatic system.

– this indicator determines the rate of fibrin clot formation when calcium ions are added to the plasma. Reflects the activity of the blood coagulation system.

Activated plasma recalcification time– its meaning is similar to the previous indicator, only the methodology for determining the criterion changes. Examined as part of the basic definition of a coagulogram.

– also included in the basic analysis, characterizes the speed of the first phase of coagulation. Used as a diagnostic criterion for the effectiveness of anticoagulant drugs.

Almost all of these compounds are enzymes, so their activity is measured as a percentage. A decrease in these indicators means a decrease in the amount of this enzyme in the blood, which may be evidence of various diseases.

Second phase of blood clotting

– reflects the activity of the so-called internal pathway of activation of the hemostatic system.

– is one of the indicators of the basic coagulogram; along with prothrombin time, it reflects the work of internal activation of blood coagulation. Reflects the saturation of the body with vitamin K and liver function.

Third phase of blood clotting

– a criterion showing the rate of transition of a certain amount of soluble fibrinogen into insoluble fibrin protein.

– this protein is constantly present in the blood; under the influence of blood clotting factors, it polymerizes into insoluble fibrin, which is the basis for the formation of blood clots. Both a decrease and an increase in this indicator leads to significant disturbances in the hemostatic system.

is a transitional soluble form between fibrinogen and fibrin. A certain amount of it is always present in the blood, but with blood clotting disorders, the level of these complexes changes.

Additional tests for coagulogram

When determining even an extended coagulogram, some of the most important indicators that could accurately indicate the source of the pathological condition still remain “overboard”. Therefore, sometimes additional biochemical studies are prescribed, the purpose of which is to determine the following blood components:

These indicators mainly indicate the functioning of the body's anticoagulation system, and also reflect various pathological changes in key criteria.

It is one of the most active enzymes of the fibrinolytic (anti-coagulation) blood system. Therefore, any changes in its activity will invariably entail disturbances in the hemostatic system.

– This soluble protein is a breakdown product of fibrin. Therefore, its high content in the blood indicates increased activity of the fibrinolytic system, which entails a decrease in blood clotting.

Antithrombin-3 is an enzyme similar in function to protein C and therefore reflects the same changes in the body as this fibrin-splitting protein.

– this indicator, when positive, indicates that a person has an autoimmune disease. At the same time, the body's own defense system attacks and destroys platelets, leading to blood clotting disorders.

– most often this indicator is determined within the framework. Platelets play a central role in the formation of a blood clot, so their number is a reliable indicator of the state of the hemostatic system.

Blood clotting is a reliable mechanism for protecting our circulatory system. A huge number of pathologies and diseases of various organs can affect its functioning, which greatly complicates their course. Therefore, monitoring the functioning of hemostasis by determining the coagulogram is a reliable method for diagnosing a huge number of diseases and preventing their complications.

Any doctor begins to treat a patient only after collecting an anamnesis and a series of laboratory tests to make a correct diagnosis. Today we’ll talk about a coagulogram - what kind of analysis is it, and in what cases is it prescribed? Coagulation testing is an important laboratory blood test that gives an idea of ​​the development of the disease, allows you to make an accurate diagnosis and select the optimal treatment method.

Coagulogram: what is it?

Coagulogram (hemostasiogram) is a special study that allows you to determine blood clotting indicators. In simple terms, this is a test that shows whether blood clots well or poorly. This study gives an idea of ​​the state of hemostasis and allows us to identify conditions such as hypo- or hypercoagulation.

Hypercoagulation (increased blood clotting) indicates the risk of thrombosis and the development of dangerous pathologies such as thromboembolism or thrombosis.

Good to know

Hypocoagulation (reduced coagulation) - can lead to bleeding that threatens the patient’s life.

These indicators are very important to consider when preparing for surgery and other medical procedures. The result of a coagulogram helps determine how the operation or childbirth process will go, whether it will be possible to stop the bleeding and save the patient in emergency situations, when time counts in seconds.

Who is prescribed a coagulogram test?

Doctors advise doing a coagulation test before any surgical intervention, but a coagulogram becomes especially important during pregnancy. For women carrying a child, this test is mandatory; it is taken three times during the course of the test, which makes it possible to promptly identify and exclude many problems, including such a dangerous condition as placental abruption. In addition, the following conditions are indications for a blood clotting test:

• severe gestosis in a pregnant woman;
• preparation for surgical interventions (including cesarean section and childbirth);
• varicose veins and high risk of thrombosis;
• taking certain medications (hormones, anabolic steroids, oral contraceptives) that affect blood clotting;
• severe liver damage (cirrhosis);
• inflammatory processes in the body that occur in acute form;
• cardiovascular pathologies accompanied by a high risk of thrombosis (coronary disease, atrial fibrillation);

A coagulogram is often prescribed to assess the general state of hemostasis, and is also used to monitor the patient’s condition during therapy with anticoagulants - blood thinning drugs.

It is worth considering a coagulogram in case of such alarming signs as those that are difficult to stop or the frequent appearance of hematomas on the body that form even in the absence of bruises. In addition, it is recommended to do a coagulogram if you plan to resort to such an alternative method as hirudotherapy (treatment with leeches).

Coagulogram indicators

In its expanded form, the analysis of a coagulogram in adults includes many indicators. Therefore, in practice, when conducting a study, an optimal set is selected, by which one can judge the coagulation properties of blood.

• Coagulogram PTI or prothrombin index. Just like PTT (prothrombin time), this value shows how long it takes for a blood clot to form at the site of injury.
• Coagulogram APTT (activated partial thrombin time) is an indicator that determines how quickly a fibrin clot appears. This is one of the most accurate and sensitive indicators, allowing one to judge how effectively plasma blood factors work. At the same time, a shortening of the APTT value will indicate an increase in coagulability and the risk of thrombosis, and a lengthening will indicate hypocoagulation and the likelihood of bleeding.
• Plasma fibrinogen. This is a special protein that, at the final stage of blood plasma coagulation, is converted into fibrin and provokes the formation of blood clots.
• Thrombin time (TV) - This indicator indicates how long it takes for fibrin to be formed from fibrinogen.

In addition, there are a number of advanced coagulation parameters that help determine exactly where in the blood coagulation system the failure occurred. These include factors such as prothrombin time, bleeding time, antithrombin, plasma recalcification time, RFMC and other values.

In medical practice, they resort to two types of coagulograms - basic and detailed. In the first, basic version, the study makes it possible to determine disturbances in hemostasis, while an advanced analysis gives an idea of ​​the causes of such deviations, helps to make an accurate diagnosis and differentiate the disease from other pathologies with similar ones.

Interpretation of blood coagulogram

A blood test for a coagulogram needs to be able to read and analyze correctly. Not every doctor has the skills to decipher indicators; only a highly qualified specialist can correctly evaluate and interpret certain hemostasiogram parameters. Decoding the analysis consists of comparing the obtained values ​​with the normal blood coagulogram.

So, when determining blood clotting time, the normal indicator is up to 15 minutes. Exceeding this value indicates a deficiency of prothrombin and fibrinogen and is an expected consequence of the administration of anticoagulants.

The normal prothrombin index (PTI) ranges from 12 to 20 seconds. An extension of this time indicates disruptions in the synthesis of prothrombinase, prothrombin and fibrinogen. Such changes accompany vitamin deficiencies, chronic liver pathologies, disturbances in absorption processes in the intestine, or are a consequence of taking indirect anticoagulants. The indicator is expressed as a percentage. In a healthy person it is at the level of 97-107%

When determining APTT, the normal value is from 38 to 55 seconds. A decrease in this value indicates a risk of developing thrombosis, and an increase indicates a congenital deficiency of clotting factors (hemophilia) or is observed during heparin therapy.

Fibrinogen - this enzyme is synthesized in the liver. A decrease in this indicator indicates the presence of pathologies such as vitamin deficiency, toxicosis of pregnancy, liver damage (hepatitis, cirrhosis). An increase in value is observed at the initial stage of myocardial infarction, during inflammatory and infectious processes in the body, hypothyroidism or tissue necrosis.

Here is what a table with blood coagulogram indicators looks like:

In this case, the doctor must take into account that coagulogram indicators in children and adults differ. Thus, the value of prothrombin time for premature newborns is from 14 to 19 seconds, for full-term infants - from 13 to 17 seconds, and in healthy older children - from 12 to 16 seconds.

Antithrombin III (physiological anticoagulant) levels also depend on age. So, if in newborn children a value of 40-80% is considered normal, then in adolescents this figure should be in the range of 80-120%, and in adults - from 75 to 125%.

To fully assess blood clotting factors, a specialist needs to study at least 13 indicators, including taking into account the expanded components of the coagulogram. Additional indicators allow you to more accurately see the picture of the disease, make the correct diagnosis and prescribe treatment.

Coagulogram during pregnancy

During pregnancy, a woman's body is rebuilt in preparation for upcoming motherhood. Changes also affect the hemostatic system, which is due to hormonal changes and the appearance of an additional, utero-placental circulation.

During this period, coagulation results usually show an increase in the activity of coagulation factors and an increase in fibrinogen. In this case, fragments of fibrin are deposited on the walls of the vessels of the additional circulation, and fibrinolysis processes are suppressed, which prevents the formation of blood clots and placental abruption. Due to these changes, the woman’s body is protected from the risk of uterine bleeding and miscarriage.

With the pathological course of pregnancy and manifestations of gestosis, a violation of the regulation of blood clotting occurs. If you do not start timely treatment, you may develop a dangerous complication - disseminated intravascular coagulation syndrome. Its development is accompanied by the formation of many small blood clots and disruption of the blood supply to the fetus. In severe cases, uterine bleeding occurs, which leads to fetal death and poses a threat to the woman’s life.

Good to know

Therefore, during the process of bearing a child, a blood coagulogram is performed in each trimester of pregnancy, which helps prevent possible thrombotic complications, avoid miscarriage and prepare for the upcoming birth.

Rules for preparing for a coagulogram

It is necessary to prepare correctly for passing an important test. The basic rules of preparation should be explained by the attending physician. They are as follows:

• on the eve of the test, you must refrain from eating heavy, fatty foods and exclude any alcoholic beverages;
• in the evening a light dinner is allowed, for example, stewed vegetables with a piece of boiled dietary meat;
• blood is taken for analysis in the morning, on an empty stomach;
• Before collecting material, you should not smoke, drink tea or coffee;
• 20 minutes before entering the treatment room, you can drink 200 ml of regular drinking water;

If the patient is being treated with anticoagulants, they should be stopped before taking the test to avoid distorting the results of the hemostasiogram. In cases where taking such drugs is a vital necessity, the laboratory assistant who will perform the analysis should be warned about this.

You should donate blood against the background of overwork and stressful situations. A few days before collecting the material, you must stop taking any medications. In case of intolerance to the sight of blood, severe dizziness, or fainting, you need to warn the laboratory assistant about this. In this case, when drawing blood, the patient is placed on a couch.

How is blood drawn?

Material for analysis is taken from a vein using a dry, sterile syringe without using a tourniquet. The syringe must be equipped with a wide bore needle. The puncture of the vein should be as less traumatic as possible, otherwise a lot of tissue thromboplastin will get into the pre-prepared test tube with a special coagulant, which can ultimately distort the result of the coagulogram. After drawing blood, the laboratory assistant fills 2 test tubes with the material and sends one of them for testing.

Where can I get the analysis done?

A standard analysis can be done at any public clinic whose laboratory has the necessary reagents for. In most cases, an extended coagulogram can be done only in paid medical centers. This is a rather complex study that requires highly qualified laboratory technicians. As a rule, the analysis results will be ready in two days.

The price that must be paid for the study largely depends on the number of parameters that need to be determined during a hemostasiogram, and varies from 2000 to 3500 rubles.

Synonyms: coagulogram, hemostasiogram

A coagulogram is a comprehensive hematological test that allows you to assess blood clotting ability. The study is prescribed after a serious injury and before surgery to prevent bleeding or blood clots.

Also, studying coagulogram parameters is necessary when diagnosing hereditary and acquired diseases of internal organs (kidneys and liver, blood vessels, heart). Monitoring blood clotting is mandatory during pregnancy and in cases of diagnosed autoimmune disorders.

General information

Hemostasis is a blood clotting system that protects the human body from excessive blood loss as a result of injuries, ruptures of vascular walls and tissues of internal organs, and surgery.

Regulation of hemostasis is provided by the endocrine and nervous systems. Blood transports oxygen and energy components to cells and regulates body temperature precisely due to its “fluidity”. In the case of hypocoagulation (decreased coagulation), a person rapidly loses blood even with a minor injury or cut. Hypercoagulation (increased coagulability) leads to the accumulation of blood clots (thrombi), which clog the lumen of arteries and veins, preventing the free movement of biological fluid through the bloodstream. As a result, ischemia and tissue necrosis develop, the dangerous complications of which are cerebral stroke and myocardial infarction.

If hemostasis functions normally, then the blood clots just enough to plug gaps in the arteries and veins (this process is not always noticeable to humans).

Hemostasis is ensured by the following components:

• endothelium (inner layer lining blood vessels) – when the integrity of the vascular walls is damaged, its cells produce bioactive substances that trigger thrombus formation;
• platelets (red blood cells) are the first to go to the site of the rupture, stick together and, thereby, clog the wound, that is, create a hemostatic plug;
• plasma factors and enzymes (up to 15 components) - trigger chemical reactions, which result in the formation of a dense fibrin clot that stops bleeding.

Indications for analysis

A coagulogram is prescribed by a therapist or hematologist when diagnosing the following conditions:

• pathology of the structure or inflammatory processes of internal organs;
• tendency to form blood clots;
• thromboembolism (blockage with blood clots) of the pulmonary artery;
• history of stroke or heart attack;
• anomalies in the structure and functioning of blood vessels (small and medium veins, arteries);
• hemorrhagic disorders:
  • von Willebrandt's disease (spontaneous bleeding);
  • thrombocytopenia (platelet deficiency);
  • thrombocytopathy (increased secretion of platelets);
  • hemophilia (deficiency of clotting factors), etc.
• atrial fibrillation (chaotic (erratic) heart contractions);
• coronary heart disease (damage to the heart muscle due to insufficient blood supply);
• DIC syndrome (thrombosis in small vessels);
• cirrhosis of the liver (pathological change in structure) in chronic form;
• pathological pregnancy, history of miscarriage;
• preparation for natural childbirth or caesarean section;
• gestosis (complication of toxicosis of the 3rd trimester of pregnancy).

The study is also carried out in the following cases:

• general and comprehensive assessment of the state of hemostasis;
• planned analysis before surgery;
• control of drug treatment:
  • anticoagulants;
  • heparin;
  • oral contraceptives;
  • hormones;
  • glucocorticosteroids;
  • anabolic steroids.

Reference values ​​for coagulogram

A coagulogram is a complex test that involves the study of several components together. Each of them has its own set time for research, as well as a unit of measurement.

Clotting time

The time interval between the start of bleeding and its stop. The rate of fibrin clot formation is assessed.

• Venous blood should clot in 5-10 minutes, and capillary blood should clot faster (in 30 seconds - 5 minutes).

The ratio of blood clotting time (normal) to the patient's blood clotting time.

• The obtained relative indicators range from 97-100%, and in pregnant women they can reach 150% or more.

Prothrombin is also measured according to Quick, where the normal range is 78-142% (including in expectant mothers). Reference values ​​allow you to determine liver dysfunction.

The rate of transformation of blood fibrinogen into fibrin.

• The normal range for this test is 10.3-16.6 seconds, and for pregnant women - 11-18.

When the interval lengthens, fibrinogen is found in excess, and when the interval is shortened, there is a deficiency of this protein component. It also allows you to assess the performance of the liver.

The test results reflect the rate of blood clotting and also make it possible to predict the risks of bleeding or thrombosis.

Most often, a lupus anticoagulant is determined in patients with a prolonged aPTT and a tendency to thrombosis, which is characteristic of antiphospholipid syndrome (APS).

• Normal time is less than 1.2 seconds.

The D-dimer test allows you to evaluate two factors in combination: coagulation (blood clotting) and fibrinolysis (dissolution of clots). The marker makes it possible to promptly detect an imbalance between them in the case of diseases of the circulatory system (varicose veins, thrombophilia, pulmonary embolism, etc.).

• Normally, the level should be below 243 ng/ml. In pregnant women, values ​​may increase depending on the trimester.

The study makes it possible to timely diagnose thrombotic conditions and predict the risk of developing diseases associated with blockage of veins and arteries. Plasminogen is also assessed during the preparation and management of pregnancy in order to prevent possible complications.

Normally, the amount of plasminogen in the blood fluctuates within

• 80-132%

In newborns and children up to 6 months, the norm is 60% of the figure for adults.

Activated recalcification time (ATR)

The rate of restoration of the concentration of calcium ions in the blood plasma to normal levels.

• In healthy people, the figure is 50-70 seconds.

Plasma recalcification time (PRT)

This coefficient correlates with the AVR and allows you to determine the clotting time of citrate serum (obtained according to the previous principle) when adding calcium salts.

• The time should be at least 1-2 minutes.

Produced in the liver, where under the influence of coagulation factors it is converted into fibrin. The threads of the latter, in turn, form blood clots. To begin hemostasis, a person needs at least 0.5 g of fibrinogen. In this case, fibrinogen B should not be detected in the plasma.

• The normal level of this component is 2-4 g/l (5.9-11.7 µmol/l),
• in pregnant women it can reach 6 g/l.

Soluble fibrin-monomer complexes (SFMC)

They directly affect the molecular structure of fibrin with the participation of plasmin and thrombin (clotting factors).

• Normally, the figure is up to 4 mg per 100 ml.

This test is specific and sensitive for preventing the occurrence of DIC.

Fibrinolytic activity

It is an important indicator of the coagulogram, which indicates the ability of the blood to independently dissolve the resulting blood clots. This process is ensured by fibrinolysin.

Thrombotest

The study is carried out to visually calculate the volume of fibrinogen in the test plasma.

• The norm is a result of 4-5 degrees.

The norm is 83-128%.

Antithrombin belongs to the proteins of the anticoagulation system and inhibits thrombin (inhibits blood clotting). If the indicator decreases, thrombosis may develop. Monitoring the indicator is important when taking anticoagulants (heparin).

Plasma tolerance to heparin

Time of fibrin clot formation after adding heparin to plasma.

• The normal range is 7 to 15 minutes.

This study determines the concentration of thrombin.

Blood clot retraction

During the analysis, the gradual reduction of the blood clot with its separation from the plasma is assessed.

• Measured in relative values: 44-65%.

Duke bleeding time

Included in a complex coagulogram, but this test evaluates capillary rather than venous blood.

The doctor pierces the finger with a special lancet at least 4 mm. The blood that oozes from the wound is removed with a special napkin every 15-30 seconds (contact with skin is unacceptable). After each subsequent blotting, the time until a new drop is released is recorded. The time for complete cessation of capillary bleeding is also assessed, which is normally 1.5-2 minutes.

A referral for a coagulogram can be issued by a general practitioner, therapist, functional diagnostician, pediatrician, etc. But a comprehensive assessment of the indicators and their interpretation should be performed by an experienced hematologist.

Preparing for analysis

Biomaterial for research: venous blood.

Method of collecting biomaterial: standard venipuncture.

Manipulation time: from 8.00 to 11.00.

Required conditions: strictly on an empty stomach! Before venipuncture, fasting for 10-12 hours is indicated, while the dinner on the eve of the test should be light. In the morning before the analysis, you can drink plain water, exclude soda, tea, coffee drinks, and juices.

Basic training requirements

• 3 days in advance – avoid drinking alcohol;
• For 1 day – limit physical and emotional stress as much as possible (heavy lifting, stressful situations);
• The day before - remove fatty, spicy, smoked, salty foods from the diet;
• 2-3 hours before – smoking is prohibited.

Additionally

You must inform your doctor in advance about current courses of drug treatment. In this case, it is advisable to indicate their name, duration of therapy, dosage, etc.

Important! The results of the study may be affected by taking hormonal drugs (including contraceptives), aspirin, anticoagulants, so it is advisable to do a coagulogram 2 weeks after treatment.

Read more about blood clotting indicators

Doctors prescribe many different tests for every sick person. However, not everyone knows what they are all intended for. This article will discuss what a blood coagulogram is.

Designation of concepts

Let's understand the basic concept that will be actively used in this article. So, a blood coagulogram is an analysis of its homeostasis. In other words, the blood clotting system itself will be examined.

Blood clotting is the process of its thickening from a liquid consistency to the state of a so-called clot. This is a natural phenomenon, a certain protective reaction of the body to blood loss. The coagulation process itself is regulated by such important systems as the endocrine and nervous systems.

Preparing for tests

How to donate blood for a coagulogram, what do you need to know for this? First of all, it is worth saying that it is necessary to prepare for this procedure in advance. Only in this way will the results obtained be correct and will be able to indicate either the presence of problems or their absence.

1. Before taking the test, you should not eat for 10-12 hours. That is why this analysis is taken in the morning. The patient is told not to have breakfast. That is, the analysis is taken on an empty stomach.
2. In the evening, on the day before donating blood, the patient is recommended to have a light dinner without fatty foods, smoked foods, or fried foods.
3. You can drink it in the morning before the test. However, only clean water without gas. Coffee, tea, juices are prohibited.
4. If the patient smokes, you should abstain from cigarettes for an hour before taking the test.
5. Doctors recommend: before taking a blood test for a coagulogram, you need to drink a glass of clean water (200-250 ml).
6. On the day of the test, it is not recommended to overexert yourself both physically and emotionally.
7. Immediately before blood sampling, the patient should be calm and balanced. The pulse should return to normal.
8. If a person is taking medications that affect blood clotting, be sure to tell doctors about this.
9. If the patient does not tolerate the process of blood sampling, specialists should also be warned about this.

How and from where?

If a patient is prescribed a coagulogram, where is the blood taken from in this case? The sample will be taken from a vein. The resulting liquid is placed in test tubes (up to a certain mark), into which a preservative was added the day before.

1. The puncture site is pre-treated with alcohol (but not ether!).
2. The puncture is made only after the alcohol has completely dried.
3. It is best not to apply a tourniquet before drawing blood. The thing is that constriction of a human limb activates blood clotting, in which case the results may be distorted.
4. The first 5-6 drops of blood are not allowed into the test tube (they are blotted with a swab), as they may contain tissue thromboplastin.

Important: if the patient is prescribed several tests, blood is taken at the very beginning for a coagulogram, fibrinogen and prothrombin index.

Indications

When can a blood coagulogram be prescribed?

1. If the patient has problems with blood clotting.
2. This analysis is mandatory for patients undergoing surgery.
3. If the patient has uterine or other bleeding.
4. This analysis is needed for those patients who are being treated with anticoagulants.
5. If the patient has a history of heart attack or stroke.
6. This analysis is needed for people who have problems with the liver or vascular function.
7. In case of autoimmune diseases, it is also necessary to donate blood for a coagulogram.
8. The test is often prescribed for pregnant women.
9. The indication for its examination is varicose veins of the lower extremities.

Clotting time

Among the main indicators of a coagulogram, blood clotting time is distinguished. So, doctors determine how long the blood will flow, for example, from the moment of the cut until it stops completely. Normal interval:

• from 30 seconds to 5 minutes, if we are talking about capillary blood;
• about 10-15 minutes if it is venous blood.

This indicator allows you to judge how well platelets cope with their task. When the duration of bleeding from a wound may be increased:

1. If there is a lack of vitamin C in the body.
2. If for a certain reason the platelet count is reduced.
3. If the patient takes anticoagulants for a long time - for example, Aspirin.
4. For hemophilia or liver disease.

Blood may clot faster than the presented indicators if the patient is taking hormonal contraceptives or has previously had heavy bleeding.

PTI

This is the prothrombin index. This indicator is very important, as it allows you to monitor the condition of the liver. Its normal value: 80-120%. PTI may increase in the following cases:

1. If a woman is pregnant (this is normal).
2. If the patient is taking oral contraceptives.
3. If there is a risk of blood clots that are dangerous to the body.

If the PTI is below normal, this is fraught with bleeding for the patient. And in order for this indicator to be within standard limits, the patient must take vitamin K.

Thrombin time

What other indicators are important if a patient is prescribed a blood coagulogram? This is thrombin time. Normally it is 15-20 seconds. During this period, the process of converting fibrinogen into fibrin is measured. If this indicator can be obtained over a longer period of time, this may indicate the following problems:

• there is an excess of fibrinogen in the patient’s blood;
• there is a lack of protein in the body;
• severe renal failure developed.

If the patient is treated with a drug such as Heparin, this indicator must be strictly monitored. How is it designated in medicine? Blood coagulogram - INR, i.e. international normalized treatment.

APTT

This abbreviation stands for “active partial thromboplastin time.” It is worth saying that this is the most sensitive indicator of blood clotting. It demonstrates how quickly a blood clot forms after calcium chloride or other components are added to the plasma. The normal rate is 30-40 seconds. If the blood coagulogram (APTT) is higher than normal, this may indicate that the patient has a diseased liver or a lack of vitamin K in his body.

AVR

This is the activated recalcification time. This indicator allows you to find out how one of the stages of blood clotting occurs. Normal data: 50 to 70 seconds. If the readings are lower, this may indicate that the patient has a thrombophilia condition. If the time period is significantly longer, the reason may be the following:

• a significant decrease in the number of platelets in the blood;
• heparin therapy;
• one of the critical conditions: trauma, burn, shock.

Fibrinogen concentration

Normal value: from 5.9 to 11.7 µmol/l. It can decrease with various liver diseases. Increases in the following situations:

1. If the patient has malignant tumors.
2. For acute infectious diseases.
3. With a lack of thyroid hormones.

RFMK

This indicator stands for “soluble fibrin-monomer complexes.” This is a marker of intravascular coagulation. It demonstrates changes in fibrin under the influence of thrombin and plasmin. Upper limit of normal: 4 mg/100 ml. It can change depending on the same reasons as fibrinogen.

Thrombotest

What does a blood coagulogram show if an indicator such as thrombotest is considered? It allows you to detect the amount of fibrinogen contained in the patient’s blood. Normal indicators: thrombotest grade 4 or 5.

Tolerance to plasma heparin

This indicator indicates the amount of thrombin in the blood. In this case, it will be possible to see how long it takes for a fibrin clot to form in the blood plasma (this should happen after heparin is introduced into the blood). Normal values: 7-15 minutes. Blood resistance to heparin decreases if the patient has liver problems (15 minutes or more). Hypercoagulation (which is typical for pregnant women), the presence of cancerous tumors, diseases of the cardiovascular system, as well as the postoperative period - these problems can cause indicators in which blood tolerance is less than 7 minutes.

Fibrinolytic activity

This indicator allows you to determine how much blood can independently dissolve blood clots. Fibrinolysin, which is found in the plasma and can break down the structure of the blood clot, is responsible for this. If a patient’s blood clots dissolve faster than normal, then he or she is at risk of bleeding.

Duke indicators

If the patient needs to undergo a blood test for a coagulogram, the duration of bleeding according to Duke can also be examined. In this case, the patient's finger will be pricked. The penetration depth of the lancet (special instrument) is 4 mm. Then, approximately every 20-30 seconds, drops of blood will be removed from the patient using special paper. After removing one drop, the doctor times the time during which the next one appears from the wound. In this way, the patient's capillary blood clotting is checked. Ideally, this indicator should fluctuate between one and a half to two minutes.

Fibrinogen

I would like to remind you once again what a coagulogram examines - blood clotting. It is very important to study a protein synthesized by the liver called fibrinogen. Under special conditions, it is synthesized in the hematopoietic system into such an important substance as fibrin. Normal fibrinogen content in the blood of a healthy person: 2-4 g/l. When indicators can be reduced:

1. If a woman has toxicosis while carrying a baby.
2. If the patient has cirrhosis of the liver.
3. In very severe forms of a disease such as hepatitis.
4. In case of failures in homeostasis.
5. If there is a lack of B vitamins or ascorbic acid in the body.
6. These indicators may decrease if the patient takes fish oil, anabolic steroids or anticoagulants.

Fibrinogen levels exceed the norm in the following cases:

1. For acute infections.
2. For pneumonia.
3. In inflammatory processes.
4. While carrying a baby.
5. After childbirth.
6. After operations.
7. In case of heart attack or stroke.
8. After receiving burns.
9. As a consequence of taking hormonal contraceptives.

Important: fibrinogen B must be negative.

Blood clot retraction

When taking a blood coagulogram, the norm for this indicator should be from 45 to 65%. In this case, the decrease in the volume of the blood clot is studied, its reduction along with the release of blood serum. Indicators increase as a result of anemia. They decrease if the patient’s platelet count decreases or red blood cell count increases.

GRP

This indicator provides information about the time of plasma recalcification. Normal: from 60 to 120 seconds. This is one of the most important indicators of homeostasis. If the time is less than specified, we can say that the patient has hyperactive blood clotting.

A few words about children

It is important to say that in young patients some indicators will differ slightly from the norms presented above, while others will differ significantly. So, for example, the optimal amount of fibrinogen in a child’s blood is about 1.25-3.00 g/l. At the same time, in an adult it is 2-4 g/l. This test can be prescribed for children in the following situations:

1. Before surgery.
2. With frequent bleeding.
3. If there is a suspicion of hemophilia or other diseases that affect the circulatory system.

A few words about pregnant women

For women who are pregnant, this test is done three times in 9 months (once in each trimester). This is very important, since the hormonal system of a pregnant woman changes, which affects homeostasis (the changes are not pathological, but physiological, i.e. normal). Also, this study will help identify the threat of miscarriage or premature birth (which often occurs as a result of blood clots). In the first trimester, blood clotting rates may increase, but closer to childbirth they may decrease. All this is normal, because in this way the body tries to protect itself from possible bleeding and large blood loss. If the doctor is not satisfied with the results obtained, the woman will have to take this test again. If a pregnant woman is prescribed a coagulogram (blood test), the norm will be slightly different than that of a healthy person:

1. Thrombin time: 11-18 seconds.
2. Fibrinogen: 6 g/l.
3. Prothrombin: 78-142%.
4. APTT: 17-20 seconds.

If a woman is pregnant, it is very important for her to study an indicator such as prothrombin. Its deviation from the norm may indicate that the patient is at risk of pathological

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

Hemostasis is a special system in the body, the main task of which is to maintain blood in a liquid state in the vessels, stop bleeding in damaged vessel walls and prevent the formation of blood clots. Blood clotting 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.

Detailed blood coagulogram

The indicators that are included in the blood test for a coagulogram are relative. To complete the study, it is important to evaluate each blood clotting factor in a detailed coagulogram. There are 13 of them, and omission when analyzing 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 studied, the level of which, together with other analyzes of primary hemostasis, will allow one to judge the general coagulation properties. To do this, it is also necessary to know the total number of platelets in the blood, 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 necessary to obtain the results of all indicators and determine the components of the blood.

A detailed coagulogram includes obtaining data on:

Blood clot retraction;

Thrombotest;

Plasma tolerance to heparin;

Fibrinolytic activity.

Abbreviated coagulogram - what kind of analysis is it?

A shortened set of indicators includes:

Coagulogram indicators

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

The method for determining blood clot retraction is similar to the method for determining thrombin time; it allows one to determine both the coagulability of a blood clot and the degree of its compression; the norm 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 coagulation. The norm of quantitative value is 40-95%. A decreased reading may be caused by thrombocytopenia; an elevated reading may indicate anemia.

Thrombotest - assessment of the presence in the blood. Normal thrombotest - grade 4-5. Fibrinogen levels should be between 2.7 and 4.013 grams. If the level of this protein increases, the blood becomes thicker, and this can lead to the onset of blood clots. For pregnant women, this rate may vary slightly.

The process of determining plasma heparin tolerance examines how quickly a fibrin clot can form when heparin is added to the blood. Ideally, this process should last 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 us to identify the ability of the blood to independently dissolve formed blood clots over a certain period of time. The value is significantly influenced by the presence of fibrinolysin in plasma. The norm is 183-263 minutes. Indicators below normal indicate an increased degree of bleeding.

In what cases is a coagulogram indicated?

There are many situations in life in which it is extremely important to know clotting indicators, therefore such a study is of significant importance and is indicated for:

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

Preparation for various types of operations;

Various diseases of blood vessels;

after heart attacks and strokes;

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

Identifying the reasons for the decrease in the immune functions of the body’s defenses;

Monitoring the condition of women during pregnancy and before childbirth. During this period, 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 likelihood of complications during childbirth, because some deviations from the norm can cause miscarriage, premature placental abruption, or lead to severe bleeding. To monitor a woman’s condition during pregnancy, the test must be taken every trimester, and when the results are received, an increase in clotting is often noted - this is how the body reduces the risk of possible blood loss.

A blood clotting test is also necessary for the correct prescription of drug treatment when using drugs that stabilize various parameters of the body. In case of cardiac arrhythmia, varicose veins, stroke and coronary heart disease, a hemostasiogram analysis is carried out to monitor the effect of medications and timely diagnosis of possible abnormalities.

How to take a blood coagulogram test?

It is important to follow some recommendations when taking the test 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.

Alcohol consumption is prohibited, including low-alcohol drinks and beer.

Physical stress on the body should be avoided 2-3 days before the test.

When taking any medications (especially anticoagulants), you should notify your doctor about this; you may need to wait 1-2 weeks for their effect to cease and be removed from the body.

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

You should not take a coagulogram test against the background of strong emotions 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 proper rest.

If you experience severe dizziness at the sight of your own blood or injections, you should definitely warn the nurse about this.

Interpretation of coagulogram results

Clotting time

To determine it, take 2 ml of blood from the cubital vein. After this, 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 monitor the moment a clot appears. A reliable result is considered to be the average value obtained from 2 test tubes, while the norm is considered to be 5-10 minutes.

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

Prothrombinase deficiency;

Fibrinogen deficiency;

Vitamin C deficiency.

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

If in a detailed coagulogram the blood clotting value is reduced, then this condition is called hypocoagulation. In this case, the blood clots poorly or does not clot at all, which can lead to large blood losses even with minor vascular damage. Hidden internal bleeding is especially dangerous, since it is not always possible to recognize it in a timely manner.

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

Prothrombin time

The determination of prothrombin time is almost the same as that of coagulation, with the exception of the addition of calcium chloride solution and thromboplastin solution to the blood. The blood clotting rate 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, a lack of vitamins in the body, and dysbacteriosis.

High coagulogram values ​​may indicate the use of indirect coagulants; such treatment requires constant monitoring. The dosage is selected in such a way that the indicator increases no more than 2 times. Hormonal contraceptives can also increase the prothrombin index.

ATCHV

ATPV is the plasma response to the addition of erythrophosphatide and cephalin, which helps to identify coagulation failure and is also considered the most sensitive indicator. Normal APTT is 38-55 seconds. If the value is less than the minimum threshold, then blood clots may form.

Plasma fibrinogen

The determination method is based on the property of plasma to transform into fibrin after adding special substances to it. After conversion, the fibrin strands are weighed. This allows you to obtain 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. A reading above the upper limit of normal coagulogram may indicate:

The presence of an infectious disease;

Development of malignant tumors;

Development of acute or chronic inflammatory processes;

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

Disorders of the thyroid gland.

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