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

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

Expanded blood coagulogram

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

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

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

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

A detailed coagulogram includes obtaining data on:

Retraction of a blood clot;

Thrombotest;

Plasma tolerance to heparin;

fibrinolytic activity.

Abbreviated coagulogram - what is this analysis?

The reduced set of indicators includes:

Coagulogram indicators

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

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

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

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

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

In what cases is a coagulogram shown?

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

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

Preparation for various kinds of operations;

Various diseases of the blood vessels;

after heart attacks and strokes;

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

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

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

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

How to take a blood coagulation test?

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

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

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

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

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

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

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

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

Interpretation of the results of the coagulogram

Clotting time

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

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

Insufficiency of prothrombinase;

fibrinogen deficiency;

Vitamin C deficiency.

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

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

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

prothrombin time

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

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

ATCV

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

Plasma fibrinogen

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

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

The presence of an infectious disease;

The development of malignant tumors;

Development of acute or chronic inflammatory processes;

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

Disruption of the thyroid gland.

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

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

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

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

The main parameters of the coagulogram

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

Additional coagulogram tests

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

Coagulogram: grounds for appointment

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

Preparing for a blood coagulation assessment

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

Normal values ​​of the main indicators of the coagulogram

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

Interpretation of coagulogram results

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

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

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

Features of the coagulogram in pregnant women

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

A coagulogram is an important analysis that determines the indicators of blood clotting. It is prescribed during pregnancy, before surgery and with a tendency to thrombosis.

Coagulogram - what is this analysis?

Coagulology or coagulation is a branch of hematology that studies the process of blood clotting, its biochemistry and physiology. An analysis that determines coagulability indicators is called a coagulogram. With its help, the activity of platelets in the human body is established.

If it is reduced, there is a high risk of bleeding and the appearance of difficult-to-heal wounds. When elevated, blood clots can form, leading to serious illness.

Coagulation study is indicated in the following cases:

A coagulological study is carried out with severe bleeding in order to establish their cause or before surgery.

The tests help doctors prescribe the correct dosage of anticoagulants and monitor health conditions when taking oral contraceptives, which can cause blood clots.

It is worth thinking about passing a coagulogram in case of bruising even after minor bruises and in the presence of frequent bleeding.

Why they are tested depends on the state of human health and the presence of chronic diseases. The indicators of the coagulogram make it possible to assess not only the state of the blood, but also to identify some chronic pathologies of the internal organs. The analysis is included in the complete examination of the body.

Thrombus formation

How to take a coagulogram?

In order to prepare for the delivery of a coagulogram, you must follow simple rules:

• Blood for a coagulogram is taken strictly on an empty stomach. For 8 hours before taking the analysis, it is forbidden to eat.
• The use of alcoholic beverages is contraindicated.
• An hour before you donate blood, you can not take tea, coffee and juices.
• You can drink a glass of water about 20 minutes before the procedure.
• You should not take the analysis in stressful situations and fatigue, as the results may be distorted.

Preparation for analysis is no different from that which is carried out in other studies. The best time to donate blood is early in the morning before breakfast. In the treatment room, a person is located in the supine position on the couch.

During the analysis, it is necessary to inform the doctor about taking any medications, as this may affect the result.

Where is blood taken for coagulogram?

The material is taken from a vein or a finger, after which the area from which the analysis is taken is clamped with a cotton swab until the blood stops completely. The resulting material is placed in a test tube, and the study is carried out by a device - a coagulometer.

How many days is the analysis done and what is the price of a coagulogram?

Depends on the laboratory, but usually the results are ready the next day. The price varies within small limits and does not exceed 1500 rubles. An extended coagulogram costs about 3,200 rubles. In the direction of a doctor, analysis in public clinics is carried out free of charge.

Basic indicators

Coagulation analysis allows you to identify a list of indicators that together give a complete assessment of the state of human blood.

The main ones are presented in the table:

Indicator	Description	Norm
Prothrombin	It is one of the most important indicators of the coagulogram and characterizes the state of coagulation. Its departure from the norm occurs in case of a violation of blood clotting. An increase occurs in people prone to thrombosis.	70-120
prothrombin time	Plasma clotting time per second.	11-16 seconds
INR (international normalized ratio)	Shows the ratio of prothrombin time to the average level of this value. It is given when taking anticoagulants at least 1 time in 3 months. With an increase, we can talk about a tendency to bleeding, and a decrease - the risk of thrombosis.	0,85-1,35
Prothrombin index	The ratio of normal plasma coagulation to that found in the patient. An increase indicates a tendency to form blood clots, and a decrease indicates the risk of bleeding.	0.8
fibrinogen	In medicine, it is characterized as a protein that forms the basis of a blood clot. Activated release is possible with inflammatory processes and the risk of cardiovascular pathologies. The decrease occurs with a tendency to bleeding, with liver diseases.	5.9-11.7 µmol/l
APTT (activated partial thromboplastin time)	With a deviation from the norm in a smaller direction, it indicates a tendency to blood clots, and an elongation indicates a decrease in the tendency to bleeding.	35-45 seconds
Antithrombin III	It is a natural anticoagulant that inactivates thrombin and reduces clotting.	66 - 124 %

The main indicators of the coagulogram are the clotting time and the interval during which a dense clot is formed, which helps stop bleeding. You can get other coagulability indicators during an extended coagulogram .

Formation of a dense clot

An extended coagulogram allows you to identify a number of hereditary diseases, but it is not performed in all laboratories due to lack of equipment.

The indicators that allow you to identify a detailed coagulogram include:

Indicator	Description
thrombin time	Thrombin solution is added to the plasma and its ability to clot is determined. Normally, it leaves 15-18 seconds. Increases when fibrinolytic activity is reduced or liver tissue is affected.
Blood clot retraction	Coagulability and degree of clot compression (0 - absent, 1 - present). The norm is from 40 to 95%. A decrease occurs with thrombocytopenia, an increase - anemia.
Plasma recalcification time	The time it takes for a clot to form when blood plasma and calcium chloride solution are mixed. The norm is 1-2 minutes.
Thrombotest	Visual assessment of the presence of fibrinogen in the blood. Norm - 5 - 4 degree. Grade 6 indicates the risk of thrombosis, occurs with diseases of the liver and blood, as well as after burns and injuries.
Plasma tolerance to heparin	Formation of a clot when heparin is added to the blood. The lengthening of the indicators indicates a decrease in tolerance. The norm is 7-15 minutes.
fibrinolytic activity	The ability of the blood to dissolve blood clots. The norm is 183-263.

Decoding of coagulometry should be carried out exclusively by the attending physician. The specialist evaluates the result individually in each case.

The rate can be affected by:

• Pregnancy.
• lactation period.
• The presence of chronic diseases.
• Past injuries and burns.

Coagulogram during pregnancy

The period of pregnancy is characterized by global changes in organs and systems, and especially in hemostasis. This can be explained by the appearance of an additional circle of blood circulation and changes in the hormonal background, which contributes to an increase in the activity of coagulation factors.

During pregnancy, fibrin fragments are deposited on the walls of the vessels of the placenta. Thus, the body protects itself from uterine bleeding and miscarriages.

In each trimester, the indicators of the norm of hemostasis differ mainly upwards. The table shows the norms for women in the 1st-3rd trimester.

Indicator	1 trimester	2 trimester	3rd trimester
platelets	300-317	270-300	240-260
fibrinogen	2,91-3,11	3-3,46	4,42-5,12
PTI	85-90	91 -100	105-110
APTT	35,7-41,2	33,6-37,4	36,9-39,6
RFMK	80-130	85-135	90-140
Antithrombin III	0.22	0.18	0.15

In case of violation during pregnancy, there are changes in the coagulogram parameters up or down.

Women who do not see a doctor and do not conduct an examination can get DIC, which develops in 3 stages:

Coagulogram when planning pregnancy

During pregnancy planning, the further course of fetal development depends on the coagulogram data. Most indicators can deviate slightly during gestation, and this is a normal process. But a significant deviation from the norm indicates the presence of deviations that can cause a miscarriage and threaten the life of a woman.

Increased blood clotting can cause placental abruption, severe bleeding and fetal hypoxia.

It is important to conduct blood tests both during pregnancy planning and during gestation. The smallest deviations from the norm should alert the specialist. If necessary, additional studies are prescribed to make the correct diagnosis and prescribe the correct treatment.

The norms of the coagulogram in children practically do not differ from those found in adults.

All data is entered into a table and analyzed. Only in rare cases, it is difficult for doctors themselves to determine the presence of certain abnormalities.

Most often this occurs with chronic liver diseases and problems of the immune system.

The norms of the coagulogram in children 3-14 years old are presented in the table:

Indicator	Norm
platelets	200-400
fibrinogen	200-400
prothrombin time	15-21
thrombin time	10-15
Antithrombin III	85-110
Duke bleeding time	2-4

The analysis should be carried out in the following cases:

The interpretation of the analysis is carried out exclusively by the doctor. The specialist not only compares the indicators with the norm, but also takes into account other factors that may affect the distortion of the result.

As a result, the coagulogram allows you to identify the presence of vascular, inflammatory and autoimmune diseases.

A coagulogram is an important analysis that allows you to identify the first changes in blood coagulation. You can conduct a study in almost any laboratory, however, a detailed analysis requires additional equipment. During pregnancy, the delivery of a coagulogram is free of charge.

Video: Blood tests. What are they talking about?

Coagulogram (or hemostasiogram)- an analysis necessary to assess the ability of blood to clot. It is able to indicate the tendency of a pregnant woman to form blood clots or bleeding, which helps to prevent the development of pathologies of fetal formation, placental abruption and complications during childbirth.

Indications and preparation for donating blood for a coagulogram

During pregnancy, there are three planned blood donations for a coagulogram:

1. Immediately after registration for pregnancy.
2. Between 22-24 weeks.
3. Between 30-36 weeks.

Unscheduled blood donation for a hemostasiogram is performed according to indications:

• prolonged previous infertility;
• complications (multiple pregnancy; pregnancy resulting from IVF; as well as fetal lag in fetal development; early or late preeclampsia; fetoplacental insufficiency);
• varicose veins in the expectant mother;
• the formation of hematomas (bruises) after minor bruises, nosebleeds, bleeding gums when brushing teeth;
• smoking and other bad habits of a pregnant woman;
• the need for evaluation of liver function. In this case, the hemostasiogram allows assessing the functioning of the liver by monitoring the formation of prothrombin complex factors in it;
• monitoring the state of the blood coagulation system in women who have been treated for a long time with direct anticoagulants (for example, Heparin);
• suspected bleeding disorder.

To obtain reliable indicators of blood clotting, you need to do a hemostasiogram on an empty stomach. It is not recommended to eat 8 hours before the test, including drinking juices, tea, coffee. Refrain from eating sweets (including chewing gum with sugar). You can drink only clean water without gas.

Half an hour before donating blood, you should refrain from smoking if the expectant mother has such a bad habit. It is also not recommended to physically overstrain 30-40 minutes before the test. Emotionally, a woman should be calm, only slight excitement is permissible.

Blood for analysis is taken from a vein in the crook of the arm.

Interpretation of coagulogram indicators

With a simple hemostasiogram, it is necessary to reveal:

• Prothrombin + INR
• fibrinogen
• thrombin time

An extended coagulogram is prescribed if there are deviations in a simple coagulogram or is performed immediately instead of it. Then additionally indicate:

• Antithrombin III (AT3)
• D-dimer
• Lupus anticoagulant

The direction for an extended hemostasiogram is issued according to indications. These include:

• habitual miscarriage;
• previous prolonged infertility;
• intrauterine fetal death in the past;
• multiple pregnancy;
• hereditary blood diseases;
• severe forms of toxicosis (gestosis).

The analysis is deciphered by the attending physician in the antenatal clinic.

The norms of coagulogram indicators necessary for deciphering the results of the analysis

Prothrombin + INR

Prothrombin(factor II) is one of the main factors of blood clotting. With the timely detection of a deviation of this indicator from the norm, the doctor is able to prevent the development of thrombosis, placental abruption or the appearance of bleeding during delivery. That is why it is desirable to conduct a coagulogram in each trimester of pregnancy.

In addition, the level of prothrombin allows the doctor to assume the presence of malfunctions in the liver and digestive system of a woman. How is prothrombin associated with these organs? - you ask.

The answer is that prothrombin is produced in the liver with the participation of vitamin K. One part of this vitamin is produced by the intestinal microflora, and the other part enters the body with food that must be digested in order to get the coveted vitamin K.

In the process of digestion, the gastrointestinal tract and the liver are involved, because it produces bile for gastric juice. And if the level of prothrombin is lowered, then:

1) the liver does not cope with its duties;

2) absorption of vitamin K from the gastrointestinal tract is difficult (for example, due to diseases such as enterocolitis or ulcerative colitis);

3) the production of vitamin K is not completely due to the disturbed intestinal microflora.

In this case, additional blood tests for liver enzymes (ALT and AST) are prescribed, which are most often included in the biochemical blood test “plus”, referrals are issued for a repeated general blood and urine test (possibly feces). If necessary, ultrasound of these organs or other diagnostic studies may be prescribed.

Modern laboratories measure prothrombin according to Quick (in%). The normal value of prothrombin is in the range of 78-142%.

Some laboratories only calculate the prothrombotic index (PTI). Its norm in different laboratories has its own, it must be learned from the laboratory assistant.

An elevated level of prothrombin (more than 142%) can be detected with:

• tendency to form blood clots. These include pre-infarction conditions and myocardial infarction, thromboembolic conditions, elevated blood globulins and hypohydration, which arose due to increased blood viscosity;
• taking drugs that inhibit the action of coumarin (for example, vitamin K) or can reduce it (meprobamate and corticosteroids).

If prothrombin is lowered (less than 78%), then:

• hypofibrinogenemia, characterized by low levels of fibrinogen in the blood;
• lack of vitamin K in the female body (hemorrhagic diathesis in a baby);
• insufficiency of the coagulation factor prothrombin, as a result of which the pregnant woman has a tendency to bleed.

The expectant mother's intake of anticoagulants and coumarins, as well as drugs that enhance their effect, also leads to a decrease in prothrombin in the blood.

INR (International Normalized Ratio) shows the rate of formation of a blood clot. An analysis to determine the level of prothrombin + INR is regularly prescribed for people who take anticoagulants - drugs that prevent thrombosis.

If the expectant mother is being treated with direct anticoagulants, then the results of the coagulogram should also indicate the value of the International Normalized Ratio, which the woman must inform in advance so that the INR (INR - International normalized ratio) is additionally calculated for her.

If a woman is not treated with blood-thinning drugs, then the INR value is usually not indicated in the analysis results (it is simply not calculated, because this is not necessary).

The INR of a healthy person is in the range of 0.8-1.2. But depending on the disease and the tactics of its treatment, the normative range may be different. Therefore, for each patient, the rate of this indicator is determined by the attending physician and is called the “target INR range”.

If INR below normal, then the dose of anticoagulant is insufficient and the risk of thrombosis is still high.

If INR above normal, then the selected dose of anticoagulant is excessive and now the risk of bleeding increases.

Thus, the calculation of the INR is necessary to adjust the dosage of the drug prescribed to reduce the risk of thrombosis.

APTT

APTT (activated partial thromboplastin time)- the period of time during which a blood clot forms.

In the laboratory, this time is determined using the following experiment. First, blood plasma is separated, and then reagents are added to it (calcium salt of hydrochloric acid, kaolin-kephalin mixture, and others). This imitates the beginning of the natural process of blood clotting in the human body.

As a result of the experiment, the presence of factors involved in coagulation or their deficiency is established. The presence in the blood of components that slow down the clotting process is also determined. And, of course, the very time during which a blood clot is formed is detected.

The normal value of APTT for expectant mothers is in the range of 17-20 seconds.

For a non-pregnant woman, the APTT norm is included in the following time frames 24.0 - 38.2 seconds.

APTT = 21 seconds or more. If, after adding reagents to the blood plasma, a clot has formed for longer than 20 seconds, then this indicates a tendency to bleed due to the presence of a woman:

• the second or third phase of disseminated intravascular coagulation (DIC);
• hemophilia A, B, C;
• increased production of antibodies to phospholipids.

APTT can be increased when the expectant mother is treated with heparin, therefore, in order to obtain a reliable result, it is necessary to cancel heparin 2 days before the analysis or donate additional blood for lupus anticoagulant and antibodies to cardiolipin.

APTT = 16 seconds or less. And if the clot formed in less than 17 seconds, then this indicates:

• the initial phase of DIC, characterized by increased blood clotting, when, when injured, clots form rapidly in large blood vessels, and blood clots in small ones;
• thromboembolism or thrombosis;
• increased content of activated coagulation factors;
• injury during blood sampling for analysis (the analysis must be retaken, it is better to take blood from a vein of the second hand).

fibrinogen

Another factor in blood clotting is fibrinogen. fibrinogen(factor I) is a special protein that is supposed to be considered the main component of a blood clot. In healthy people, it is produced by the liver and distributed throughout the circulatory system. At the site of damage to the vessel wall, fibrinogen is converted into insoluble fibrin, which becomes the basis of a thrombus. Such a thrombus clogs the damaged vessel, thereby stopping the bleeding.

Only with a sufficient number of components of the blood clot, the thrombus is stable and remains at the site of injury to the vessel until healing. If there is a deficiency of factors I and II, a person is prone to increased bleeding, and with an excess of it, thrombosis is observed without damage (that is, pathological blood clots are formed that can break away from the walls of blood vessels and block the blood flow).

Fibrinogen is measured in mg/dl or g/l. To obtain the value of the component in g/l, it is necessary to calculate according to the formula:

mg/dL 0.01 0.555 = g/L.

Fibrinogen rate:

• up to about 12 weeks of pregnancy - this is 2.00-4.00 g / l;
• from 3 months to the end of the gestation period, an increase in fibrin to 6.5 g / l is permissible;

The fibrinogen level should not fall below 0.5 g/l. This is a critical level of fibrinogen in the blood.

An increase in fibrinogen levels may indicate:

• the course of an acute disease of an inflammatory and infectious nature (for example, influenza);
• lack of hormones produced by the thyroid gland;
• violation of protein metabolism;
• recent surgery;
• increased estrogen content;
• extensive burn.

Low fibrinogen (less than 2.0 g/l) may result from:

• DIC;
• lack of vitamins B12 and C;
• toxicosis;
• heart failure;
• acute promyelocytic leukemia;
• complications after childbirth;
• severe liver damage;
• thrombolytic therapy.

thrombin time

Thrombin Time (TV)- this is the time during which a clot forms after mixing blood plasma with thrombin. During pregnancy, the norm of TV is from 10.3 to 25 seconds.

An increase in TV (more than 25 seconds) indicates:

• low fibrinogen (up to 0.5 g/l);
• liver pathology due to the presence of fibrinogen defects at the molecular level;
• fibrinolytic therapy;
• high content of bilirubin in the blood serum;
• the presence of direct anticoagulants in the blood during treatment with heparin or other similar drugs.

Low TV (less than 10.3 seconds) is observed with:

• high levels of fibrinogen in the blood;
• the initial stage of the development of DIC.

Antithrombin III

Antithrombin III (AT3)- a complex protein produced by vascular and liver cells, and inhibiting the process of blood clotting. It is necessary in order to prevent the increased formation of blood clots (thrombi).

Normally, AT3 is 70-120%.

High AT3 (more than 120%) is observed with:

• acute hepatitis;
• the presence of inflammation;
• cholestasis;
• severe course of acute pancreatitis;
• treatment with anticoagulants;
• lack of vitamin K.

Reduced AT3 (less than 70%) may be due to:

• congenital deficiency of antithrombin III;
• acute DIC;
• atherosclerosis;
• chronic liver failure;
• heparin treatment;
• blockage of a vessel by a thrombus.

D-dimer

D-dimer is an indicator that characterizes the process of thrombus formation and fibrin dissolution. Normally, by the end of pregnancy, it rises 3-4 times from the initial level. But the increase in D-dimer should be gradual. Rapid growth can indicate pregnancy complications, possible kidney disease and diabetes.

The norm of D-dimer depends on the laboratory.

For the independent laboratory "Invitro" and the clinic "Euromed" standard values ​​for pregnant women:

• I trimester - less than 286 ng / ml;
• II trimester - less than 457 ng / ml;
• III trimester - less than 644 ng / ml.

The D-dimer value should not fall below 33 ng/ml.

For the AltraVita clinic, the norm of D-dimer during pregnancy is different:

• I trimester - from 0 to 525 ng / ml;
• II trimester - from 438 to 1200 ng / ml;
• III trimester - from 888 to 2085 ng / ml.

The Helix laboratory service has its own D-dimer norms for pregnant women:

• up to 13 weeks - 0-0.55 mcg / ml;
• 13-21 weeks - 0.2-1.4 mcg / ml;
• 21-29 weeks - 0.3-1.7 mcg / ml;
• 29-35 weeks - 0.3-3 mcg / ml;
• 35-42 weeks - 0.4-3.1 mcg / ml.

Unit conversion:

µg/ml 1000 = ng/ml

ng/ml 0.001 = µg/ml

For example, 500 ng/mL = 0.5 µg/mL.

An increase in the level is observed in the presence of:

• deep vein thrombosis, pulmonary embolism;
• DIC;
• infection, sepsis;
• inflammation (with a slight increase in the value of D-dimer);
• liver disease;
• extensive hematomas.

After thrombolytic therapy or surgery (even after tooth extraction), the value of D-dimer may increase. Late toxicosis also contributes to an increase in this indicator.

Lupus anticoagulant

Lupus anticoagulant (LA) Antibodies that prevent the conversion of prothrombin to thrombin. Normally, VA is absent during pregnancy. The appearance of antibodies speaks of autoimmune diseases (for example, systemic lupus erythematosus, antiphospholipid syndrome), when the body accepts its own cells as foreign, and begins to fight them. As a rule, in the presence of VA in the blood, an increase in APTT is also observed.

Standard result in seconds - 31-44 sec.

Identification of VA occurs when:

• blockage of the vessel by a thrombus (thrombosis, thromboembolism);
• with persistent miscarriage due to antiphospholipid syndrome (APS);
• ulcerative colitis;
• rheumatoid arthritis or other autoimmune diseases;
• the presence of infectious diseases (HIV, EBV, parvovirus B19, hepatitis).

VA can be detected in human blood, but in small amounts up to 1.2 conventional units (in some laboratories up to 9 c.u.). If lupus anticoagulant is conditionally absent, then “negative” is recorded in the results of the analysis, and “positive” if it is present in the blood.

Treatment with anticoagulants can lead to a false positive result, so testing for lupus anticoagulant should be performed before heparin or heparin replacement therapy.

If an extended coalogram is performed during treatment with heparin, then a positive VA result should not be ignored.

Depending on the amount of antibodies in the sample, a comment is attributed: “weak”, “moderately” or “significantly”.

A coagulogram (hemostasiogram) is one of the most important tests in a laboratory blood test. It is necessary for a detailed study of the ability of blood to coagulate.

It is prescribed, as a rule, when carrying a child, in case of a patient's predisposition to the formation of blood clots, and also before a serious surgical intervention. Each person should have an idea of ​​what kind of analysis it is, how it is carried out, and what it can show.

Description

A hemostasiogram is a laboratory study of blood fluid that allows you to evaluate hemostasis - a complex biosystem that is necessary to maintain the fluid properties of blood, dissolve formed blood clots in a timely manner, and help stop bleeding.

To maintain basic functions, blood must meet the following requirements:

• have a sufficiently liquid consistency, which allows you to provide vital organs and tissues with oxygen and the necessary nutrients through their movement through the blood vessels, control the functioning of the protective properties of the body, and promote the elimination of toxic substances;
• maintain a certain degree of viscosity to close the gaps in the vessels in case of injury.

If there is a decrease in coagulability to a critical level, then with intense bleeding, the body dies.

Increased blood viscosity and clotting (hypercoagulation) provoke the formation of its clots, which can provoke the development of a stroke, thromboembolism or heart attack as a result of the overlap of important vascular systems.

Conducting a coagulogram is necessary, since control of hemostasis helps prevent the formation of blood clots, blood loss and clogging of blood vessels.

This study is one of the most difficult, since a specialist must have all the necessary knowledge to assess the state of not only each specific indicator, but also all of them.

Research types

The hemostasiogram is classified into two types:

• basic;
• expanded (extended coagulogram).

The first type allows you to identify only existing violations in hemostasis.

In the second, a complete study is carried out, which makes it possible to establish the cause of the pathological process and differentiate the disease from other disorders that have a similar effect.

In addition, an important component is the conduct of a qualitative and quantitative analysis of violations.

Why carry out

The analysis includes the evaluation of many indicators. Everything will depend on the goal. For each person, specific parameters are indicated.

In most situations, a coagulogram involves the study of the following values:

1. Prothrombin. This is a complex protein, the amount of which indicates the general state of hemostasis. An increase in normal values ​​indicates a predisposition to the formation of thrombosis, and a decrease indicates bleeding.
2. Norm of the prothrombized index. Assess how long the patient's blood coagulates.
3. Activated partial thromboplastin time is the time it takes for a blood clot to form.
4. INR - the ratio of prothrombized time to its average value. If the indicator is too high, then the patient is predisposed to bleeding, if it is underestimated, to thrombosis.
5. fibrinogen. It is considered one of the main proteins in the formation of a blood clot during the clotting period. Its increase will indicate the development of inflammation. In addition, there may be disturbances in the work of the heart and vascular system. If the protein is present in a reduced amount, then we can talk about liver disease or a predisposition to bleeding.
6. Antithrombin 3. Helps reduce coagulability.
7. Thrombosed time - the duration of the final stage of coagulation.
8. Platelet concentration.
9. D-dimer. Necessary to control the thrombus formation process. With its rapid increase, the risk of having diseases of the blood, kidneys or diabetes mellitus increases.
10. . In a normal state, it should not be. The presence of this parameter indicates autoimmune disorders in the human body.

During the study, all 3 stages of blood clotting should be checked.

When appointed

According to the advice of most experts, it is necessary to do a coagulogram before the operation, regardless of its complexity. In addition, the analysis is necessary during pregnancy.

Also among the indicators for biochemical analysis are:

• severe preeclampsia in pregnant women;
• preparation for surgery;
• varicose veins;
• high tendency to thrombosis;
• the use of a certain number of medications that can affect blood clotting;
• cirrhosis of the liver;
• acute inflammation;
• diseases of the cardiovascular system (ischemia, atrial fibrillation).

Often, a hemostasiogram is prescribed to assess the general state of hemostasis, as well as to monitor the patient's condition during therapeutic measures that involve treatment with anticoagulants.

Also, the study is done with serious prolonged bleeding or hematomas on the body, which can form even in the absence of mechanical damage.

Normal performance

Normally, the values ​​of the parameters in adults are equal to those given in the table below.

Clotting time
Prothrombin index
thrombin time	11-17.8 seconds
fibrinogen concentration
fibrinogen	5.9-11.7 µmol/l
Fibrinogen B	negative
fibrinolytic activity	183-263 minutes
Activated Recalcification Time (ART)	50-70 seconds
Activated partial thromboplastin time (APTT)	24-35 seconds
Thrombotest	IV-V degree
Plasma tolerance to heparin
Duke bleeding time
Retraction of a blood clot
Soluble fibrin-monomeric complexes ()	up to 4 mg/100ml
Plasma recalcification time (PRT)	60-120 seconds

In children, as a rule, the data are somewhat different. During the neonatal period, fibrinogen should be in the range of 1.25-3.00 g / l.

Norms in childhood:

In pregnant women, the indicators will be as follows:

Indicator	1 trimester	2 trimester	3rd trimester
platelets
fibrinogen
Antithrombin III

How to donate blood for analysis

To get the most reliable results, you need to properly prepare for the study.

Training

Before screening, the patient must follow all the recommendations that the specialist will give him:

1. Refuse to eat 12 hours before the session. If you can not avoid dinner the day before, then preference should be given to light meals.
2. Stop taking all medications that involve minor breaks.
3. Eliminate any drinks from the diet, especially alcohol. You are allowed to drink clean water.
4. Reduce physical activity.
5. Do not stress the body.
6. Do not smoke at least one hour before the procedure.

If you do not follow these rules, then the likelihood of obtaining false data increases.

Holding

Donate blood for analysis exclusively on an empty stomach. You can take it from a finger or a vein.

After all devices and the place where the biomaterial is taken from are disinfected, the laboratory assistant makes a puncture in the area of ​​​​the skin with minimal trauma, which must also be observed in order to exclude data distortion as a result of penetration of thromboplastin tissues.

To exclude this possibility, it is necessary to fill two test tubes with the material. The latter is sent for research. If blood is taken from a vein, then the tourniquet is not used.

In addition, a special substance, a coagulant, must be added to the test tube.

The procedure itself is painless. Unpleasant sensations occur only at the time of puncture of the skin. After a coagulogram, there may be slight weakness in the arm.

Data interpretation

The interpretation of the results is carried out exclusively by a specialist. This takes into account all the indicators that were described above.

When making a final diagnosis, it is also necessary to take into account the medical history, the results of the examination of the patient, and a general blood test.

Generally speaking, an excess of the parameters of normal values ​​will indicate a thickening of the blood fluid, and a decrease will indicate a deficiency of platelets in the blood.

How many days is the study

The period required for the study will depend on many predisposing factors.

In most cases, a coagulogram is done for a maximum of 1-2 days. Sometimes it can take up to ten days. Everything will depend on the serviceability of the equipment, the workload of the laboratory and the worker. With an additional payment for urgency, the results of the analysis are issued on the day of its delivery.

Coagulogram for children

The procedure is prescribed for a child in the following cases:

• the planned surgical intervention;
• frequent bleeding is diagnosed, and there are also wounds that heal for a long time.

In addition, a blood test is necessary if there is a suspicion of the development of pathological processes that adversely affect blood clotting.

When done to women in position

During pregnancy, the body is restructured for the upcoming motherhood. Changes do not bypass the hemostasis system, which is caused by a violation of the hormonal background and the formation of an additional circle of blood circulation.

During this period, the parameters of the coagulogram will indicate an increased activity of factors that are responsible for blood clotting, as well as an increase in fibrinogen.

Parts of fibrin begin to be deposited on the vascular walls of the uteroplacental circle. Against this background, the process of fibrinolysis is suppressed, preventing thrombosis and placental abruption.

These changes allow you to protect the body of the expectant mother from a natural termination of pregnancy and the development of bleeding in the uterus.

If the period of bearing a child is complicated by pathologies and the manifestation of preeclampsia, blood clotting is disturbed.

In the absence of timely treatment, DIC may develop, which is characterized by the formation of a large number of small blood clots and impaired blood flow to the fetus. In more severe cases, uterine bleeding is not excluded, which is dangerous not only for the fetus, but also for the life of a woman.

To prevent such conditions, it is recommended to do a hemocoagulogram every trimester.

Cost of the procedure

The price will depend on the equipment used and the amount of work carried out. For example, a basic study will cost 700-1500 rubles. The cost of the extended one will vary within 3500 rubles.

During pregnancy, if you have a compulsory health insurance policy, the procedure is carried out free of charge, since the examination in this case is mandatory.

A coagulogram is one of the most important laboratory techniques that allows you to determine all the parameters of blood coagulation.

The procedure is prescribed before surgery, with cardiac pathologies or during pregnancy. The results obtained allow us to assess the risks of blood clots or bleeding.